加拿大儿童细菌性鼻窦炎并发颅内感染。

文献信息

中文摘要

目的： 儿童细菌性鼻窦炎并发颅内感染罕见；然而，某些地区提示在COVID-19大流行开始后这些并发症有所增加。在此，作者旨在描述加拿大COVID-19大流行开始前后儿童细菌性鼻窦炎并发颅内感染的流行病学。
方法： 在这项回顾性观察性研究中，作者组建了一个2016年至2022年接受手术和非手术治疗的儿童细菌性鼻窦炎颅内感染性并发症队列。按时间统计并比较病例数（2016年1月至2020年3月，COVID-19大流行前[大流行前] vs 2020年4月至2022年12月，COVID-19大流行开始后[大流行后]）。分析了患者人口学、临床、微生物学、手术和结局数据。
结果： 分析了来自加拿大7个省10个儿童神经外科中心的216例病例（大流行前106例和大流行后110例）。大流行开始前（6[IQR 5-8]例/季度）和大流行开始后（6[IQR 5-13.5]例/季度）的总体中位季度病例数相似（p = 0.51）。然而，以更小增量检查大流行后时期发现病例重新分布，在大流行早期18个月中观察到的病例较少，而在随后的大流行晚期15个月中病例数出现统计学显著且持续的增加。大流行开始后，观察到因鼻窦炎继发颅内感染需要神经外科干预的儿童比例显著增加（OR 2.35，95% CI 1.30-4.27，p = 0.005），而大流行前和大流行后时期之间严重疾病风险因素的分布没有变化。未观察到微生物学特征或结局方面与大流行相关的差异，也没有证据表明医疗系统功能受到干扰。
结论： 在COVID-19大流行开始后，因细菌性鼻窦炎导致的颅内感染病例数短暂减少后，加拿大各中心经历了病例数的持续上升，直至研究期结束（2022年12月）。这种增加以及对神经外科干预需求的增加，似乎导致了儿童神经外科界成员对细菌性鼻窦炎化脓性颅内并发症发病率增加的认知。需要更多观察性数据来确定病例数是否恢复到大流行前水平。

英文摘要

OBJECTIVE: Intracranial infections complicating bacterial sinusitis are rare in children; however, an increase in these complications after the start of the COVID-19 pandemic has been suggested in certain geographies. Herein, the authors sought to describe the epidemiology of pediatric intracranial infections complicating bacterial sinusitis before and after the onset of the COVID-19 pandemic in Canada.
METHODS: In this retrospective observational study, authors assembled a cohort of children with intracranial infective complications of bacterial sinusitis that were treated operatively and nonoperatively from 2016 to 2022. Case counts over time were tabulated and compared (January 2016-March 2020, before the COVID-19 pandemic [preonset] vs April 2020-December 2022, after the onset of the COVID-19 pandemic [postonset]). Patient demographic, clinical, microbiological, operative, and outcome data were analyzed.
RESULTS: Two hundred sixteen cases (106 preonset and 110 postonset) from 10 pediatric neurosurgical centers across 7 Canadian provinces were analyzed. Overall median quarterly case counts were similar in the period before (6 [IQR 5-8] cases/quarter) and after (6 [IQR 5-13.5] cases/quarter) pandemic onset (p = 0.51). However, examining the postonset period in smaller increments revealed a redistribution of cases, with fewer cases observed in the 18 months comprising the early pandemic period and a statistically significant and sustained increase in case counts in the subsequent 15 months of the late pandemic period. After pandemic onset, a significant increase in the proportion of children with intracranial infections secondary to sinusitis requiring neurosurgical intervention was observed (OR 2.35, 95% CI 1.30-4.27, p = 0.005), without a change in the distribution of risk factors for severe disease between preonset and postonset periods. No pandemic-related differences in the microbiological profile or outcomes were observed, and there was no evidence of disruption to the functioning of the healthcare system.
CONCLUSIONS: After a short period of reduced counts of intracranial infection cases due to bacterial sinusitis following the onset of the COVID-19 pandemic, Canadian centers experienced a sustained rise in case numbers until the end of the study period (December 2022). This increase together with a greater requirement for neurosurgical intervention appears to be responsible for the perception among members of the pediatric neurosurgical community of an increase in the incidence of suppurative intracranial complications of bacterial sinusitis. Additional observational data are required to determine whether case counts return to prepandemic norms.