This study aims to evaluate the impact of COVID-19 pandemic on the incidence, microbiological characteristics, management, and outcomes of mastoiditis and orbital cellulitis and their intracranial complications in pediatric patients. A retrospective observational study was conducted at the major pediatric hospital of Athens from 1/2018 to 12/2023. Pediatric patients (0–16 years) diagnosed with mastoiditis, orbital cellulitis, and related complications were included. Data were collected across three periods: pre-pandemic (1/2018–3/2020), during the pandemic (4/2020–6/2021), and post-pandemic (7/2021–12/2023). Statistical analyses compared demographic, clinical, and microbiological characteristics between the periods. A total of 176 cases were included (76 mastoiditis and 100 orbital cellulitis cases). The in-hospital incidence of both infections increased significantly post-pandemic compared to the period before the pandemic (mastoiditis: 5.5 vs.13.6 per 1000 admissions; orbital cellulitis: 4.8 vs. 21.8 per 1000 admissions, P < 0.001). Streptococcus and Staphylococcus species predominated across the three periods. Median (IQR) age was not significantly different between the two periods among patients with mastoiditis (pre-pandemic: 5.6 (3.5) years vs. post-pandemic: 3.3 (3.4) years, P = 0.12) and among patients with orbital cellulitis (pre-pandemic: 9.2 (6.6) years vs. post-pandemic: 8 (9.2) years, P = 0.50). Regarding the complications, the rate of intracranial empyema/abscess development among patients with orbital cellulitis, but not mastoiditis, was lower post-pandemic compared to pre-pandemic (30% vs. 10.1%, P = 0.03). Conclusion: The study findings demonstrate a significant rise in the post-COVID-19 in-hospital incidence of mastoiditis and orbital cellulitis in children. Future epidemiological surveillance of these complications and pathogen-specific dynamics, are important to develop prevention strategies for these severe pediatric infections. <Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: </entry> </row> <row> <entry align="left" colname="c1"> • The COVID-19 pandemic shifted the epidemiology of severe upper respiratory tract infections. </entry> </row> <row> <entry align="left" colname="c1"> • Data on the epidemiology of severe sinogenic and otogenic infections and their intracranial complications during and after the acute phase of the COVID-19 pandemic are limited in Europe. </entry> </row> <row> <entry align="left" colname="c1"> What is New: </entry> </row> <row> <entry align="left" colname="c1"> • This study highlights a notable increase in the in-hospital incidence of mastoiditis and orbital cellulitis during the post-COVID-19 pandemic era, likely associated with immunity debt and alterations in respiratory microbiota. </entry> </row> <row> <entry align="left" colname="c1"> • Despite the increase in pediatric mastoiditis and orbital cellulitis cases, the rates of complications and surgical management remained stable throughout the study period. </entry> </row> </tbody> </tgroup> </Table>

Impact of COVID-19 on the epidemiology of severe sinogenic and otogenic infections and their intracranial complications

期刊论文
出版模式：

开放获取
发表日期：

2025年5月24日

查看全文

Dimitra Dimopoulou,
Maria M. Berikopoulou,
Ioannis Tsoliakos,
Athanasios Michos

摘要

This study aims to evaluate the impact of COVID-19 pandemic on the incidence, microbiological characteristics, management, and outcomes of mastoiditis and orbital cellulitis and their intracranial complications in pediatric patients. A retrospective observational study was conducted at the major pediatric hospital of Athens from 1/2018 to 12/2023. Pediatric patients (0–16 years) diagnosed with mastoiditis, orbital cellulitis, and related complications were included. Data were collected across three periods: pre-pandemic (1/2018–3/2020), during the pandemic (4/2020–6/2021), and post-pandemic (7/2021–12/2023). Statistical analyses compared demographic, clinical, and microbiological characteristics between the periods. A total of 176 cases were included (76 mastoiditis and 100 orbital cellulitis cases). The in-hospital incidence of both infections increased significantly post-pandemic compared to the period before the pandemic (mastoiditis: 5.5 vs.13.6 per 1000 admissions; orbital cellulitis: 4.8 vs. 21.8 per 1000 admissions, P < 0.001). Streptococcus and Staphylococcus species predominated across the three periods. Median (IQR) age was not significantly different between the two periods among patients with mastoiditis (pre-pandemic: 5.6 (3.5) years vs. post-pandemic: 3.3 (3.4) years, P = 0.12) and among patients with orbital cellulitis (pre-pandemic: 9.2 (6.6) years vs. post-pandemic: 8 (9.2) years, P = 0.50). Regarding the complications, the rate of intracranial empyema/abscess development among patients with orbital cellulitis, but not mastoiditis, was lower post-pandemic compared to pre-pandemic (30% vs. 10.1%, P = 0.03).

Conclusion: The study findings demonstrate a significant rise in the post-COVID-19 in-hospital incidence of mastoiditis and orbital cellulitis in children. Future epidemiological surveillance of these complications and pathogen-specific dynamics, are important to develop prevention strategies for these severe pediatric infections.

What is Known:

• The COVID-19 pandemic shifted the epidemiology of severe upper respiratory tract infections.

• Data on the epidemiology of severe sinogenic and otogenic infections and their intracranial complications during and after the acute phase of the COVID-19 pandemic are limited in Europe.

What is New:

• This study highlights a notable increase in the in-hospital incidence of mastoiditis and orbital cellulitis during the post-COVID-19 pandemic era, likely associated with immunity debt and alterations in respiratory microbiota.

• Despite the increase in pediatric mastoiditis and orbital cellulitis cases, the rates of complications and surgical management remained stable throughout the study period.