Intracranial suppurative infections in pediatric patients pose a potentially deadly disease. However, there is limited data available on the management and trends of intracranial abscesses in children. Interestingly, a high frequent series of nine cases occurred from December 2022 to May 2023 after easing measures following the Covid19 pandemic. This retrospective monocentric study aims to analyze clinical features to identify areas for improvement in disease management.

A digital data query identified pediatric patients with intracranial infections. Nine cases were analyzed, and comprehensive clinical information was collected. Statistical analysis was conducted to determine significant feature correlations.

The study found a similar sex distribution with a mean age of 10.2 years. Clinical symptoms were equally divided between half neurological symptoms and the other half consisting of swelling, fever, and local symptoms. Sinusitis was identified as the cause in 75 % of the cases. Two-thirds of the cases had a favorable outcome of complete recovery. The frontal region was the most affected anatomical region. Pathogens were isolated in four out of five cases using material from brain surgery. Streptococcal infections accounted for half of the cases, while anaerobic infections and staphylococcal infections accounted for one-quarter each. Pathogens were treated with third-generation cephalosporin in 90% of cases, and metronidazole was used in 75% of cases. The study found significant associations between sinusitis and Streptococcus pyogenes, fever and temporal involvement, frontal/frontobasal involvement and temporal involvement, fever and frontal/frontobasal involvement, sex and metronidazole use, as well as sex and pathogen isolation from brain samples.

In our treatment strategy, we had no death events and approximately 22% of patients with clinical residuals. Facing the seriousness of this disease, even in the case of clinical suspicion such as the combination of sinusitis, fever and neurological disease, an unconditional image morphological clarification, ideally using MRI, must be carried out as quickly as possible. Prompt surgical removal of the abscess should be aimed for, postoperative calculated antibiotic therapy should be initiated immediately and covered following the antibiogram. Decreased transmission of respiratory pathogens during COVID-19 pandemic maybe led to a shift of incidence and a seasonal increase of intracerebral abscesses.