049 - Antibiotic Management and Imaging Practices of Sinusitis-Related Intracranial Infections among Pediatric Centers

Publication Number: 49.3690

Jenna H. Tan, University of Washington School of Medicine, Seattle, WA, United States; Matthew Kronman, University of Washington, Seattle, WA, United States; Victoria Konold, Seattle Children's, Seattle, WA, United States; Adam W. Brothers, Seattle Children's Hospital, Seattle, WA, United States; Daniel Pak, Seattle Children's, Seattle, WA, United States; Scott J. Weissman, Seattle Children's, Seattle, WA, United States; Derry R. McDonald, Seattle Children's, Lake Forest Park, WA, United States; Jeffrey Gerber, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Adam Hersh, University of Utah School of Medicine, Salt Lake City, UT, United States; Jason Newland, Nationwide Children's Hospital, Columbus, OH, United States; Ann Wirtz, Children's Mercy Kansas City, Kansas City, MO, United States

Background: Intracranial extension of pediatric sinus infections is rare but can result in life-threatening complications, necessitating prolonged hospitalization and antibiotic treatment. Significant variability exists in the antibiotic management of children with intracranial infections, including antibiotic selection, administration route, and duration. The absence of standardized U.S. guidelines makes understanding current practice variations critical to improving outcomes.

Objective: We sought to identify current management practices among pediatric infectious disease (ID) specialists treating children with intracranial extension of sinus disease.

Design/Methods: In April 2024, we sent a cross-sectional survey to pediatric ID providers from institutions in the SHARPS (Sharing Antimicrobial Reports for Pediatric Stewardship) Collaborative, which includes over 70 children’s hospitals. The survey included a clinical vignette of an 11-year-old hospitalized with an epidural empyema due to intracranial sinus extension, with 15 questions addressing topics such as the role of ID consultation, discharge regimens based on operative culture results, home antibiotic therapy, timing of transitions to oral therapy, and the use of neuroimaging.

Results: Providers at 49 of 79 SHARPS institutions responded (66% response rate). Regarding discharge antibiotics for source cultures showing typical sinus flora without Staphylococcus aureus, most (78%) reported treating these infections with both IV and oral antibiotics at discharge. While 57% of centers eventually transitioned patients to an all-oral regimen, 20 centers lacked a standardized process for this or did so infrequently. Transition points from IV to oral therapy varied, with some based on predefined IV treatment durations and others on clinical improvements. Treatment course duration and the use of imaging to guide therapy completion also varied, with many respondents’ centers lacking a standard practice.

Conclusion(s): Wide variability exists in the management of sinusitis with intracranial extension, suggesting the need for standardized guidance to ensure optimal treatment outcomes. The fact that providers at many centers are willing to treat sinusitis-related intracranial infections with an all-oral regimen suggests that assessing optimal criteria and timing for transitioning from IV to oral therapy is an area of great opportunity. Our findings highlight the need for further research to optimize care for children with these infections.

Table 1. Transition to final therapy to complete course
Discharge antibiotic regimen and route by pathogen (n=49 responses)

Table 1b. Factors used to determine timing of transition to all-oral antibiotic therapy (n=49 responses)


Table 2. Factors Establishing Duration of Antibiotic Course and Timing of Neuroimaging