The Significance of Streptococcus anginosus Group in Intracranial Complications of Pediatric Rhinosinusitis

Objective: To assess the significance of the Streptococcus anginosus group in intracranial complications of pediatric patients with rhinosinusitis. Design: Retrospective cohort study. Setting: Tertiary pediatric hospital. Patients: A 20-year review of medical records identified patients with intracranial complications resulting from rhinosinusitis. In the 50 cases identified, S anginosus was the most commonly implicated bacterial pathogen in 14 (28%). Documented data included demographics, cultured bacteria, immune status, sinuses involved, type of intracranial complication, otolaryngologic surgical and neurosurgical intervention, type and duration of antibiotics used, and resulting neurologic deficits. Complications and outcomes of cases of S anginosus group-associated rhinosinusitis were compared with those of other bacteria. Main Outcome Measures: The severity and outcomes of intracranial complications of pediatric rhino-sinusitis due to S anginosus group bacteria compared with other bacteria. Results: Infection caused by the S anginosus group resulted in more severe intracranial complications (P=.001). In addition, patients with S anginosus group-associated infections were more likely to require neurosurgical intervention (P<.001) and develop long-term neurologic deficits (P=.02). Intravenous antibiotics were administered for a longer duration (P<.001) for S anginosus group-associated infections. Conclusions: Rhinosinusitis associated with the S anginosus group should be considered a more serious infection relative to those caused by other pathogens. Streptococcus anginosus group bacteria are significantly more likely than other bacteria to cause more severe intracranial complications and neurologic deficits and to require neurosurgical intervention. A low threshold for intervention should be used for infection caused by this pathogen. JAMA Otolaryngol Head Neck Surg. 2013; 139(2): 157-160