Nonsurgical cure of brain abscess: Early diagnosis and follow‐up with computerized tomography

Berg, Bruce O.; Franklin, G.F.; Cuneo, Richard; Boldrey, Edwin; Strimling, Bruce

doi:10.1002/ana.410030603

Cited by 99 publications

(12 citation statements)

References 12 publications

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“…Eighteen patients [19,21,22,36,40,41,49,63,69,89,94,105,107,119,121,130,135,142] were known to have received antimicrobial therapy when their positive culture specimens were obtained, including abscess aspirates (12), blood (3), and contiguous-site specimens (5). Eight patients [20,29,46,47,68,79,108,141] were known not to be receiving antimicrobial therapy when culture-positive specimens were obtained, including abscess aspirates (1), blood (4), and contiguous-site specimens (3).…”

Section: Resultsmentioning

confidence: 99%

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Bamberger

1996

Clinical Infectious Diseases

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The usual treatment of bacterial abscesses, except lung or tubo-ovarian abscesses, includes therapeutic drainage. Increasing evidence suggests that some abscesses respond to antimicrobial therapy without drainage. To study this issue, a MEDLINE search of the literature was performed for cases of bacterial abscess in which treatment without definitive drainage was attempted. Four hundred sixty-five cases were identified. The most commonly involved organs were the liver, brain, and kidney. The success rate of antimicrobial therapy was 85.9%. Factors that predicted a less favorable outcome were abscess diameter of~5 em (odds ratio [OR] = 37.7; P = .0003), involvement of~1 organism (OR = 5.2; P = .014), presence of gram-negative bacilli (OR = 3.4; P = .022), length of therapy of <4 weeks (OR = 49.1; P < .0001), and use of an aminoglycoside as the only active agent (OR = 11.8; P = .008). Many bacterial abscesses can be treated without drainage; abscess size, the organisms involved, and therapy utilized may influence outcome.Bacterial abscesses usually require drainage for cure. Reasons postulated for the ineffectiveness of antibiotics in the treatment of abscesses include the presence of stationary-phase organisms, low pH, high protein content, the large number of bacteria within abscesses, ionic composition, low oxygen tension, sequestration of bacteria within leukocytes, low abscess zinc concentrations, and the presence of antimicrobial agent-deactivating enzymes [1]. Antimicrobial therapy is generally ineffective in experimental models of suppurative infections when initiation of therapy is delayed for ;?:24 hours [2].See the editorial response by Lerner on pages 604-7.It has long been recognized that lung abscesses respond to prolonged courses of antimicrobials without formal surgical drainage. Since many lung abscesses have air-fluid levels that were observed radiographically, suggesting bronchial communication, it is likely that lung abscesses spontaneously drain via the bronchial tree. It has also been well recognized that most abscesses of the tubo-ovarian region-especially those <8 em in diameter-respond to antimicrobial therapy without the need for surgical drainage [3], perhaps again because spontaneous drainage occurs via the fallopian tubes. Since the 1970s there has been an increasing number of reports of other abscesses, especially those involving the brain, liver, and kidney, that have responded to antimicrobial therapy without the need for a drainage procedure. This report reviews the literature regarding medical treatment ofbacterial abscesses in order to determine the extent of the clinical experience documented to date and to define the clinical, microbiological, and therapeutic features of abscesses responding to medical therapy. Since routine initial therapy for lung and tubo-ovarian abscesses no longer includes a drainage procedure, these cases were excluded. MethodsA MEDLINE search of the literature from 1966 to August 1994 was done to find all English-language reports of bacterial abscesses ...

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Section: Resultsmentioning

confidence: 99%

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Bamberger

1996

Clinical Infectious Diseases

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“…Fewer than 1% of brain abscesses are located in the brainstem, and these were considered lethal prior to 1974. 7,44,78,85,99,106 Since 1974, 12 children who underwent treatment for brainstem abscesses with stereotactic aspiration, microsurgery, or antibiotic therapy alone have been reported with good outcomes. 20,34,45,47,52,66,72,78,85,99,104,105 Stereotactic drainage has been performed through the right paramedian precoronal frontal or suboccipital transcerebellar approaches.…”

Section: Neurosurg Focus / Volume 24 / June 2008mentioning

confidence: 99%

Management of brain abscesses in children

Frazier¹,

Ahn²,

Jallo³

2008

FOC

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✓ Brain abscesses occur infrequently but continue to be problematic for the pediatric neurosurgical community. The incidence of brain abscesses in children has not changed much, although individual reports may show an increase or decrease in the number of reported cases depending on the patient population studied. An increase could be attributed to earlier detection due to advancements in imaging modalities and/or to an increase in the number of children with immunodeficient states caused by AIDS, chemotherapy for malignant lesions, and immunosuppressive therapy for organ transplantation. A decrease in the incidence of brain abscesses could be attributed to practices such as antibiotic treatment for otitis media, sinusitis, and/or prophylactic antimicrobial treatment for congenital heart disease in children. The morbidity and mortality rates associated with brain abscesses have not changed dramatically in the antibiotic and imaging era, and their preferred management can vary among healthcare providers. These lesions have been successfully treated by neurosurgeons. The causes of brain abscesses are highly variable in children, which is also the case in adults, but the predisposing factors in the pediatric population differ in prevalence. Cyanotic congenital heart disease, hematogenous dissemination, contiguous infection, and penetrating traumatic injuries are the most common causes of brain abscesses in children. In this review, the authors discuss the causes and medical and surgical management of brain abscesses in children.

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“…Failure to perform surgical drainage can lead to a higher mortality rate.46 A recent report on eight children with subdural empyema noted that four of these patients did not respond to appropriate antimicrobial therapy and improved only after their empyemas were drained. 47 Although proper selection of antimicrobial therapy is of primary importance in the management of intracranial infections, surgical drainage may be required. Delay in surgical drainage and decompression can be associated with high morbidity and mortality.…”

Section: Diagnosismentioning

confidence: 99%

Topical Review: Brain Abscess in Children: Microbiology and Management

Brook

1995

J Child Neurol

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Brain abscess is a serious, life-threatening infection. The infection can originate from contiguous sites of existing infections, such as chronic otitis media, dental infection, mastoiditis, or sinusitis, where anaerobic bacteria predominate. The infection can also occur in children with cyanotic congenital heart disease, in whom the predominant organisms are viridans, microaerophilic, or anaerobic streptococci, or after head trauma, in which case Staphylococcus aureus, viridans cocci, and Streptococcus pneumoniae are the most prevalent isolates. Enterobacteriaceae, Pseudomonas aeruginosa, yeast, fungi, and mycobacteria are prevalent in the immunocompromised. Radioisotope brain scans, computed tomography, and magnetic resonance imaging are important tools that enable accurate diagnosis of the infection. Proper selection of antimicrobial with good intracranial penetration is essential in the management of intracranial infection. Delay in surgical drainage can be associated with high mortality or morbidity. However, brain abscess, especially in the early phase of cerebritis, may respond to antimicrobial therapy without surgical drainage.

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Nonsurgical cure of brain abscess: Early diagnosis and follow‐up with computerized tomography

Cited by 99 publications

References 12 publications

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Outcome of Medical Treatment of Bacterial Abscesses Without Therapeutic Drainage: Review of Cases Reported in the Literature

Management of brain abscesses in children

Topical Review: Brain Abscess in Children: Microbiology and Management

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