Comparison of endoscopic sinus sampling versus intracranial sampling for microbiological diagnosis of intracranial infection in children: a case series and literature review.

التفاصيل البيبلوغرافية
العنوان:	Comparison of endoscopic sinus sampling versus intracranial sampling for microbiological diagnosis of intracranial infection in children: a case series and literature review.
المؤلفون:	Kameda-Smith MM; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK. Michelle.kameda@medportal.ca., Mendoza M; Medical School, Medical Sciences Division, University of Oxford, Oxford, UK., Brown LA; Department of Microbiology, Great Ormond Street Hospital for Children, London, UK., Hartley J; Department of Microbiology, Great Ormond Street Hospital for Children, London, UK., Aquilina K; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., James G; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Jeelani NO; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Silva AHD; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Thompson D; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Tisdall M; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Tahir MZ; Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK., Hatcher J; Department of Microbiology, Great Ormond Street Hospital for Children, London, UK. James.hatcher@gosh.nhs.uk.; Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK. James.hatcher@gosh.nhs.uk.
المصدر:	Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery [Childs Nerv Syst] 2023 Dec; Vol. 39 (12), pp. 3561-3570. Date of Electronic Publication: 2023 Jun 27.
نوع المنشور:	Case Reports; Journal Article; Review
اللغة:	English
بيانات الدورية:	Publisher: Springer International Country of Publication: Germany NLM ID: 8503227 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1433-0350 (Electronic) Linking ISSN: 02567040 NLM ISO Abbreviation: Childs Nerv Syst Subsets: MEDLINE
أسماء مطبوعة:	Original Publication: Berlin : Springer International, c1985-
مواضيع طبية MeSH:	Empyema, Subdural/diagnosis , Empyema, Subdural/microbiology , Epidural Abscess/complications , Paranasal Sinuses , Sinusitis*/complications, Child ; Female ; Humans ; Male ; Retrospective Studies ; RNA, Ribosomal, 16S
مستخلص:	Introduction: Intracranial infection is often associated with contiguous sinus infection, with Streptococcus intermedius being the most common pathogen. Microbiological assessment is possible via sinus or intracranial sampling. While a sinus approach is minimally invasive, it is not clear whether this yields definitive microbiological diagnosis leading to optimized antimicrobial therapy and avoidance of intracranial surgery. Methods: A retrospective review of a prospectively collected electronic departmental database identified patients between 2019 and 2022. Further demographic and microbiological information was obtained from electronic patient records and laboratory management systems. Results: Thirty-one patients were identified with intracranial subdural and/or epidural empyema and concurrent sinus involvement during the 3-year study period. The median age of onset was 10 years with a slight male predominance (55%). All patients had intracranial sampling with 15 patients undergoing sinus sampling in addition. Only 1 patient (7%) demonstrated identical organism(s) grown from both samples. Streptococcus intermedius was the most common pathogen in intracranial samples. Thirteen patients (42%) had mixed organisms from their intracranial cultures and 57% of samples undergoing bacterial PCR identified additional organisms, predominantly anaerobes. Sinus samples had a significant addition of nasal flora and Staphylococcus aureus which was rarely grown from intracranial samples. Of concern, 7/14 (50%) of sinus samples did not identify the main intracranial pathogen diagnosed on intracranial culture and additional PCR. Literature review identified 21 studies where sinus drainage was used to treat intracranial empyemas, with only 6 authors reporting concurrent microbiology results. This confirmed our cohort to be the largest comparative study in the current literature. No center has observed a greater than 50% concordance in microbiological diagnoses. Conclusion: Endoscopic sinus surgery may have therapeutic benefit, but it is not an appropriate approach for microbiological diagnosis in pediatric subdural empyemas. High rates of contaminating nasal flora can lead to misdiagnosis and inappropriate treatment. Routine addition of 16S rRNA PCR to intracranial samples is recommended. (© 2023. Crown.)
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فهرسة مساهمة:	Keywords: Abscess; Culture; Functional endoscopic sinus surgery (FESS); Intracranial suppurative infection; Management; Microorganisms; Sinusitis
المشرفين على المادة:	0 (RNA, Ribosomal, 16S)
تواريخ الأحداث:	Date Created: 20230627 Date Completed: 20231206 Latest Revision: 20231206
رمز التحديث:	20231206
DOI:	10.1007/s00381-023-06038-4
PMID:	37368066
قاعدة البيانات:	MEDLINE

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تدمد:	1433-0350
DOI:	10.1007/s00381-023-06038-4