Successful Treatment with Ultrasound-Guided Aspiration of Intractable Methicillin-Resistant <i>Staphylococcus aureus</i> Brain Abscess in an Extremely Low Birth Weight Infant

Abstract

Brain abscesses are an uncommon and devastating complication of bacteremia in extremely low birth weight infants (<1 kg). We report a 25-week preterm neonate who developed a brain abscess 4 weeks following methicillin-resistant Staphyloccocus aureus (MRSA) sepsis. A huge brain abscess was seen with routine brain sonography on day 19 of life. Despite intravenous vancomycin treatment, the brain abscess increased in size and was associated with increased intracranial pressure on day 49 of life. The brain abscess was accompanied by mild meningeal inflammation with negative blood and cerebrospinal fluid cultures. Diagnosis of abscess was confirmed by bedside ultrasound-guided aspiration, and MRSA was isolated from the pus culture. The MRSA brain abscess refractory to vancomycin was successfully treated by surgical ultrasound-guided percutaneous needle aspiration of brain abscess and prolonged courses of antibiotic administration. At the time of this report, the infant was 9 months old (corrected age was 6 months) and had normal neurodevelopment for her corrected age on the Bayley Infant Neurodevelopmental Screener.

Multiple brain abscesses in an extremely preterm infant and a 12-year follow up: a case report

“…There are only a few case reports about brain abscesses in EP infants [4][5][6][7][8]. To our knowledge, this is the first case report of an EP infant with a long-term follow-up.…”

“…Prognosis largely depends on early diagnosis and treatment [10]. Brain abscesses are found more frequently in cases of neonatal meningitis and septicemia [2], however, they can be diagnosed without meningitis and the positive rate of blood cultures was low [5,14,15]. This patient's blood culture and cerebrospinal fluid examination were all negative.…”

“…The non-specific and subtle manifestation, difficulties in diagnosis and treatment contribute to the poor outcomes. To our knowledge, there are only a few reports about brain abscesses in EP infants and even fewer follow-up data reported [4][5][6][7][8].…”

Multiple Brain Abscesses in an Extremely Preterm Infant and a 12-Year Follow Up: A Case Report

“…Prognosis largely depends on early diagnosis and treatment (10). Brain abscesses are found more frequently in cases of neonatal meningitis and septicemia(2), however, they can be diagnosed without meningitis and the positive rate of blood cultures was low (5,14,15). This patient's blood culture and cerebrospinal uid examination were all negative.…”

Noncontact optical imaging of brain hemodynamics in preterm infants: a preliminary study

“…blood pressure, pulse oximetry) for day-to-day management in the NICU. While recent neuroimaging researches using cranial ultrasonography (Park et al 2015) and magnetic resonance imaging (MRI) (Wang et al 2018) have provided better understanding of structural alterations associated with adverse neurodevelopmental outcomes in preterm infants, prediction of later functional disability remains modest. Moreover, large neuroimaging tools such as MRI are not practical for frequent use due to their size and cost.…”