Changes in the epidemiology of paediatric brain abscess in China: a nationwide study during the years 2016-2023

Paediatric brain abscess (BA) is a rare but life-threatening condition, and large-scale epidemiological studies are limited. We aimed to characterize the temporal trend of pediatric BA in China during 2016-2023. We conducted a nationwide study using the FuTang Update Medical Records (FUTURE) database, which includes face-sheets of discharge medical records from 33 tertiary children's hospitals across China. Case-identification strategies were validated, and the optimal strategy was applied to identify BA cases. Demographic information, predisposing factors, complications, and clinical outcomes of included cases were collected and analyzed. The main analytic cohort was constructed at the index qualifying episode level. A total of 799 children were identified, with 6.4-8.4 patients per 100,000 hospitalized children annually (P = 0.377). After 2020, the proportion of patients aged 1-3 years decreased, whereas the proportions of patients aged 10-12 and 13-17 years increased (all P < 0.05). Among predisposing factors, contiguous-site infections were more common in 2020-2023 than in 2016-2019 (OR, 1.997; 95% CI, 1.287-3.100; P < 0.001), whereas congenital heart disease remained stable. Neurosurgical intervention, complications, length of stay (LOS), and hospitalization costs were higher in 2020-2023 after adjustment for age, sex, and predisposing factors (all P < 0.05).

Although the proportion of BA among hospitalized children in China remains stable, the distribution of its predisposing factors has changed, and increases in LOS and hospitalization costs were observed.

• Bacterial meningitis was reported as the most common predisposing factor for paediatric brain abscess (BA) in a single-centre study in China during 2006-2016. • Large-scale epidemiological data on paediatric BA are limited.

• This nationwide study in China showed changes in the predisposing factors for paediatric BA from 2016 to 2023. • Contiguous-site infections increased over time and were more common in 2020-2023 than in 2016-2019.