Paediatric Immunology, Infectious Diseases and Allergy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, NE1 4LP, UK.
Erasmus MC, Rotterdam, 3015, CE, The Netherlands.
BMC Pediatr. 2019 Apr 25;19(1):130. doi: 10.1186/s12887-019-1486-7.
Paediatric focal intracranial suppurative infections are uncommon but cause significant mortality and morbidity. There are no uniform guidelines regarding antibiotic treatment. This study reviewed management in a tertiary healthcare centre in the United Kingdom and considers suggestions for empirical treatment.
A retrospective, single-centre cohort review of 95 children (< 18 years of age) with focal intracranial suppurative infection admitted between January 2001 and June 2016 in Newcastle upon Tyne, United Kingdom. Microbiological profiles and empirical antibiotic regimens were analysed for coverage, administration and duration of use. Mortality and neurological morbidity were reviewed. Data was analysed using t-tests, Mann-Whitney U tests, independent-samples median tests, and χ-tests where appropriate. P-values < 0.05 were considered statistically significant.
Estimated annual incidence was 8.79 per million. Age was bimodally distributed. Predisposing factors were identified in 90.5%, most commonly sinusitis (42.1%) and meningitis (23.2%). Sinusitis was associated with older children (p < 0.001) and meningitis with younger children (p < 0.001). The classic triad was present in 14.0%. 43.8% of 114 isolates were Streptococcus spp., most commonly Streptococcus milleri group organisms. Twelve patients cultured anaerobes. Thirty one empirical antibiotic regimens were used, most often a third-generation cephalosporin plus metronidazole and amoxicillin (32.2%). 90.5% would have sufficient cover with a third generation cephalosporin plus metronidazole. 66.3% converted to oral antibiotics. Median total antibiotic treatment duration was 90 days (interquartile range, 60-115.50 days). Mortality was 3.2, 38.5% had short-term and 24.2% long-term neurological sequelae.
Paediatric focal intracranial suppurative infection has a higher regional incidence than predicted from national estimates and still causes significant mortality and morbidity. We recommend a third-generation cephalosporin plus metronidazole as first-choice empirical treatment. In infants with negative anaerobic cultures metronidazole may be discontinued.
儿科局灶性颅内化脓性感染并不常见，但会导致较高的死亡率和发病率。目前尚无关于抗生素治疗的统一指南。本研究回顾了英国一家三级保健中心的治疗方法，并考虑了经验性治疗的建议。
对 2001 年 1 月至 2016 年 6 月在英国泰恩河畔纽卡斯尔收治的 95 名（年龄＜18 岁）局灶性颅内化脓性感染患儿进行回顾性单中心队列研究。分析微生物谱和经验性抗生素方案的覆盖范围、给药和使用时间。评估死亡率和神经功能障碍发生率。采用 t 检验、Mann-Whitney U 检验、独立样本中位数检验和 χ 检验进行数据分析，p 值＜0.05 认为有统计学意义。
估计年发病率为 8.79/百万。年龄呈双峰分布。90.5%的患儿存在易患因素，最常见的是鼻窦炎（42.1%）和脑膜炎（23.2%）。年龄较大的患儿与鼻窦炎相关（p＜0.001），年龄较小的患儿与脑膜炎相关（p＜0.001）。经典三联征的发生率为 14.0%。114 株分离菌中 43.8%为链球菌属，最常见的是米勒链球菌群。12 例患者培养出厌氧菌。31 例经验性抗生素方案中，最常用的是第三代头孢菌素加甲硝唑和阿莫西林（32.2%）。90.5%的患儿使用第三代头孢菌素加甲硝唑有足够的覆盖范围。66.3%的患儿转为口服抗生素。总抗生素治疗时间中位数为 90 天（四分位距 60-115.50 天）。死亡率为 3.2%，38.5%的患儿短期有神经功能障碍，24.2%的患儿长期有神经功能障碍。
儿科局灶性颅内化脓性感染的区域发病率高于全国估计值，仍会导致较高的死亡率和发病率。我们建议第三代头孢菌素加甲硝唑作为首选经验性治疗。对于厌氧菌培养阴性的婴儿，甲硝唑可停用。
