Fusobacterium on the Rise: A Decade of Otogenic and Beyond

BACKGROUND: Fusobacterium has become increasingly recognized pediatric pathogen, responsible for a wide spectrum of infections, including otogenic, oropharyngeal, intra-abdominal and soft tissue infections. However, large-scale studies remain limited. OBJECTIVE: This study aimed to assess the incidence, clinical features, complications and outcomes of pediatric Fusobacterium infections. METHODS: Retrospective cohort study of children (0-18 years) diagnosed with Fusobacterium infections at a tertiary pediatric hospital between 2010 and 2023. RESULTS: A total of 195 cases were identified, with a 10-fold increase in incidence over 13 years. Linear regression demonstrated a significant annual rise in Fusobacterium isolations [β = 2.25, 95% confidence interval (CI): 1.99-2.60, P < 0.01], affecting both otologic (β = 0.65, 95% CI: 0.19-1.11, P < 0.01) and nonotologic sources (β = 1.58, 95% CI: 1.23-1.94, P < 0.001). Infections were primarily otogenic (50.2%), followed by skin and soft tissue, intra-abdominal and pharyngeal infections. Patients with otogenic infections were significantly younger (mean 2.6 vs. 10.3 years, P < 0.001). Hospitalization was required in 80.5%, and complications occurred in 37%. No mortality was observed. CONCLUSIONS: Pediatric Fusobacterium infections are rising, with significant clinical complexity and complications. While often otogenic, these infections affect multiple body systems. Awareness of their evolving epidemiology is crucial for optimizing diagnosis and management.