Pediatric sinogenic and otogenic intracranial infections requiring neurosurgical intervention: a North American multicenter study in the era of COVID-19

OBJECTIVE: Early reports from single institutions have suggested that pediatric sinogenic and otogenic intracranial infections increased following the onset of the COVID-19 pandemic. Here, the authors conducted a multicenter study to confirm their hypothesis that the incidence of severe intracranial bacterial infections significantly increased across North America during that time frame and to gain insights into the mechanism and complications of these infections. METHODS: Consecutive pediatric patients from 31 North American centers who underwent a neurosurgical procedure for a sinogenic or otogenic intracranial infection from January 1, 2015, through March 31, 2023, were retrospectively identified, and information about demographics, clinical features, interventions, complications, and outcomes was collated. An interrupted time series analysis was conducted, and records of patients who presented before versus during the COVID-19 pandemic were compared. RESULTS: Of 638 patients who met inclusion criteria, 279 (43.7%) presented over a 5-year period before the COVID-19 pandemic and 359 (56.3%) presented over a 3-year period during the pandemic. There were no significant differences in age, sex, race, or ethnicity between the time periods. The interrupted time series analysis confirmed a significant increase in rates of sinogenic and otogenic intracranial infections during COVID-19. During the pandemic, more patients had public insurance (p = 0.004), facial swelling (p = 0.03), and confusion (p < 0.001) and underwent otolaryngological procedures (p = 0.03). The rate of viridans streptococcal isolation decreased > threefold during the COVID-19 pandemic, suggesting that these ubiquitous commensal organisms might play an important role in protecting against invasion by other opportunistic bacteria. There were similar rates of adverse outcomes between the time periods. CONCLUSIONS: This North American multicenter retrospective study demonstrated a significant increase in the incidence of sinogenic and otogenic intracranial infections requiring neurosurgical intervention but similar rates of adverse outcomes during the COVID-19 pandemic. Possible explanations include direct modulation of the immune system by SARS-CoV-2, a loss of certain commensal respiratory bacteria, and/or indirect effects of the pandemic.

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Journal
Journal of Neurosurgery Pediatrics
Published
2026-04-03
DOI
https://doi.org/10.3171/2025.11.peds25514
Primary Topic
Bacterial Infections and Vaccines
Type
article
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article

Pediatric sinogenic and otogenic intracranial infections requiring neurosurgical intervention: a North American multicenter study in the era of COVID-19

Gary Tye, Vijay M. Ravindra, Michael Omini, David I. Sandberg et al.
Journal of Neurosurgery Pediatrics
Bacterial Infections and Vaccines
article

Pediatric sinogenic and otogenic intracranial infections requiring neurosurgical intervention: a North American multicenter study in the era of COVID-19

Gary Tye, Vijay M. Ravindra, Michael Omini, David I. Sandberg, Jonathan Pindrik, Laurie L. Ackerman, Ariana Barkley, Guangwen Sun, Zulma Tovar-Spinoza, Christian B. Kaufman, Carolina Lopes, Victor M Lu, J Pisapia, Kurtis I. Auguste, Krystal L. Tomei, Ihika Rampalli, Michael C. Dewan, Allison Ludwick, Joshua J. Chern, Joanna Gernsback, Klaudia Dziugan, Kiefer J. Forseth, Michael DeCuypere, Moise Danielpour, David S. Hersh, B Rothstein, Nisha Gadgil, Ian C. Michelow, Weston T. Northam, Christina Notarianni, David Gonda, Julia Trout, Oritsejolomi Roberts, Albert Tu, Kentlee Battick, Joseph H. Piatt, Smruti Patel, George W. Koutsouras, Bangning N. Yu, Meredith A. Monsour, James Botros, Mary O. Haastrup, Heather J. McCrea, Howard J. Silberstein, Ali Yunus Rizvi, Amirul Anuar, Emily Dunbar, Sarah Newman, Megan E. H. Still, Sabrina L. Zeller, Robert Bollo, M. Omar Iqbal, Sarah Mierke, Lance S. Governale, Carlie Proctor, Andrew J. Witten, Helayne Okeiff, Catalina Pen-Caguin, Tomoko Tanaka, Jared Haught, Megan Votoupal, Aidan Moore, Jericho Vandr, Catherine Jay, Hannah Lehmann, Megan G. Anderson, S. Hassan A. Akbari, Catherine M. Garcia, Sharini Sam Chee
article en

Abstract

OBJECTIVE: Early reports from single institutions have suggested that pediatric sinogenic and otogenic intracranial infections increased following the onset of the COVID-19 pandemic. Here, the authors conducted a multicenter study to confirm their hypothesis that the incidence of severe intracranial bacterial infections significantly increased across North America during that time frame and to gain insights into the mechanism and complications of these infections. METHODS: Consecutive pediatric patients from 31 North American centers who underwent a neurosurgical procedure for a sinogenic or otogenic intracranial infection from January 1, 2015, through March 31, 2023, were retrospectively identified, and information about demographics, clinical features, interventions, complications, and outcomes was collated. An interrupted time series analysis was conducted, and records of patients who presented before versus during the COVID-19 pandemic were compared. RESULTS: Of 638 patients who met inclusion criteria, 279 (43.7%) presented over a 5-year period before the COVID-19 pandemic and 359 (56.3%) presented over a 3-year period during the pandemic. There were no significant differences in age, sex, race, or ethnicity between the time periods. The interrupted time series analysis confirmed a significant increase in rates of sinogenic and otogenic intracranial infections during COVID-19. During the pandemic, more patients had public insurance (p = 0.004), facial swelling (p = 0.03), and confusion (p < 0.001) and underwent otolaryngological procedures (p = 0.03). The rate of viridans streptococcal isolation decreased > threefold during the COVID-19 pandemic, suggesting that these ubiquitous commensal organisms might play an important role in protecting against invasion by other opportunistic bacteria. There were similar rates of adverse outcomes between the time periods. CONCLUSIONS: This North American multicenter retrospective study demonstrated a significant increase in the incidence of sinogenic and otogenic intracranial infections requiring neurosurgical intervention but similar rates of adverse outcomes during the COVID-19 pandemic. Possible explanations include direct modulation of the immune system by SARS-CoV-2, a loss of certain commensal respiratory bacteria, and/or indirect effects of the pandemic.

Journal of Neurosurgery Pediatrics
Northwestern University (US), Western University (CA), Cedars-Sinai Medical Center (US), Cincinnati Children's Hospital Medical Center (US), Boston Children's Hospital (US), Arkansas Children's Hospital (US), Nationwide Children's Hospital (US), Primary Children's Hospital (US), Children's Mercy Hospital (US), Johns Hopkins University (US), Emory University (US), University of New Mexico (US), University of California, San Francisco (US), New York Medical College (US), Baylor College of Medicine (US), Virginia Commonwealth University (US), SUNY Upstate Medical University (US), University of Utah (US), Louisiana State University in Shreveport (US), University of Michigan (US), Children's Hospital of Eastern Ontario (CA), University Hospitals of Cleveland (US), University of Florida Health (US), Jackson Memorial Hospital (US), University of Rochester Medical Center (US), University of Florida (US), University of California San Diego (US), Rady Children's Hospital-San Diego (US), Johns Hopkins All Children's Hospital (US), Connecticut Children's Medical Center (US), Dell Children's Medical Center of Central Texas (US), Maria Fareri Children's Hospital (US), Children's Hospital of Oklahoma (US), Lurie Children's Hospital (US), University of Kansas Medical Center (US), Children's Healthcare of Atlanta (US), Texas Children's Hospital (US), Rainbow Babies & Children's Hospital (US), University School (US), Neurological Surgery (US), The University of Texas Health Science Center (US), Children's Hospital of Richmond at VCU (US), Indiana University School of Medicine, Hartford Financial Services (United States), University of Oklahoma Health Sciences Center (US), The Ohio State University (US), University of Rochester (US), Indiana University – Purdue University Indianapolis (US), Case Western Reserve University (US), Louisiana State University Health Sciences Center New Orleans (US), UConn Health (US), University of Arkansas for Medical Sciences (US), The University of Texas at Austin (US), Vanderbilt University Medical Center (US)
Good health and well-being
Openalex Percentile: Top 32%
Bacterial Infections and Vaccines
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