Pediatric intracranial infections complicating bacterial sinusitis in Canada

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.

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.

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.

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.