Current Treatment Strategies and Factors influencing Outcome in Patients with Bacterial Brain Abscess

Abstract

We clearly determined the key to managing patients with brain abscess by retrospectively evaluating the factors affecting poor outcome in these patients. This study included 113 patients with brain abscess diagnosed in the CT era. Basic characteristics and therapeutic parameters were estimated as independent predictors of poor outcome by using univariate and multivariate logistic regression analysis. Patients with poor outcomes more frequently had deeply-located abscesses (p < 0.02), IVROBA (intraventricular rupture of brain abscess (p < 0.001) and were in a severely deteriorated neurological state (p < 0.001) than those with good outcomes. Multiple logistic regression analysis predicted that IVROBA (ORs, 24.5; 95% CI, 3.04 to 197.9) and severely deteriorated cases (ORs, 13.7; 95% CI, 2.34 to 80.8) resulting from IVROBA increased the relative risk of poor outcome. Patients with IVROBA more frequently had also deeply-located abscesses (p < 0.005), positively immunocompromised states (p < 0.05) and were in a severely deteriorated condition (p < 0.003) than those without IVROBA. Patients with metastatic abscess had also IVROBA (p < 0.006). Multiple logistic regression analysis anticipated that deeply-located abscess (ORs, 3.90; 95% CI, 1.38 to 11.04), and metastatic abscess (ORs, 12.26; 95% CI, 1.35 to 111.2) increased the relative risk of IVROBA. Patients in an obtunded state and with marked neurological deficit had IVROBA more often than patients in an alert state and/or mild neurological deficit (ORs, 3.23; 95% CI, 1.17 to 8.86, p < 0.03) before treatment. Our findings suggest that IVROBA strongly influences poor outcome in patients with brain abscess. The key to decreasing poor outcomes may be the prevention and management of IVROBA, by evaluating intracranial pressure pathophysiology. IVROBA should be aggressively treated by aspiration methods for the abscess coupled with appropriate intravenous and intrathecial administration of antibiotics.

Otogenic brain abscess and its management with review of literature

“…Therefore surgical intervention is essential once the capsule is formed. [17][18][19][20] Hence brain abscess following CSOM can be effectively managed if evolution pattern is known, as the treatment is mainly based on the stage of abscess formation.…”

The Role of18F-Fluorodeoxyglucose Positron Emission Tomography in the Treatment of Brain Abscess

“…Recently, the additional use of conventional MRI with DWI has played an important role in the diagnosis and follow-up of brain abscesses 7,10,18) . Restricted diffusion within the abscess cavity on DWI is characteristic of an abscess, which might reflect the high viscosity of protein filled fluid and the high concentration of inflammatory cells.…”

“…After fasting for at least six hours, the patients received an intravenous injection of 370 MBq (10 mCi) of 18 F-FDG and were instructed to rest with their eyes shut in a quiet room. After 40 minutes of resting, transmission CT images were performed for attenuation correction, and then emission PET images were obtained for about 10 minutes with a 336×336 matrix.…”

“…Treatment response in brain abscess has been monitored by showing the resolution of ring enhancement and the disappearance of the high-signal on DWI. However, discordance between the signal intensity on the DWI and contrast enhancement is often found despite ap- Objective : The purpose of this study was to evaluate whether 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) can be used to assess the therapeutic response of brain abscess. Methods : A study was conducted on 10 consecutive patients with brain abscess.…”

“…It has been reported that contrast enhancement did not disappear completely, although DWI demonstrated low signal on the followup 2) . Recently, several studies have reported that brain abscesses have high uptake of 18 F-Fluorodeoxyglucose (FDG) 3,8,12,17,19) . Tsuyuguchi et al 19) suggested that positron emission tomography (PET) studies might more directly reflect the degree of the inflammatory response in a brain abscess than the enhancement pattern of the computed tomography (CT) or MRI; their findings showed decreased PET tracer uptake with treatment.…”