Trends in the Management of Bacterial Brain Abscesses: A Review of 102 Cases over 17 Years

Abstract

The records of 102 patients with brain abscesses treated over 17 years were analyzed. In recent years, cardiac and pulmonary causes were less frequent, the abscesses were smaller, and fewer patients were in poor neurological condition. There has been no significant change in the type or number of infective organisms or in the number of abscesses during the study period. Computed tomographic brain scanning was the most important factor in reducing the mortality rate from 41% to 4%. The patients were grouped according to the treatment received: excision (n = 46), aspiration (n = 33), or nonsurgical therapy (n = 17). Patients treated nonsurgically were more likely to have smaller abscesses and multiple lesions than were patients in the other two groups. There were no significant differences in the morbidity or mortality rates between treatment groups. Patients whose abscesses were excised had a significantly shorter course of antibiotics than the other patients. Organisms were identified in 85% of the cultures from surgical specimens. The use of preoperative antibiotics was significantly associated with sterile cultures; 30% of patients who received antibiotics preoperatively had sterile cultures, compared with only 4% of patients who did not receive such treatment. The mortality rate among all treated patients (the diagnosis of brain abscess was missed in 6 patients before computed tomographic scanning became routine) was significantly related to the initial neurological grade and the size of the lesion but not to age, sex, or the number of abscesses. Four of the 8 treated patients who died had congenital cyanotic heart disease; an aggressive surgical approach is recommended for such patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain abscess following ischemic stroke with secondary hemorrhage

“…The treatment of brain abscess usually involves surgical drainage, performed whether by stereotactic puncture and aspiration or open surgical resection of the abscess and its capsule, followed by antimicrobial therapy for six to eight weeks. Mampalam and Rosenblum 18 reported positive cultures in 96% of the untreated patients, in contrast to 70% in those who have received any antimicrobial therapy before collecting the abscess content. In addition to that, abscesses with negative cultures have been connected with higher mortality rates 19 , probably due to inadequate antimicrobial therapy.…”

“…The advances in neurosurgical techniques and the development of last generation antibiotics have contributed to decrease the morbidity and mortality associated with brain abcesses 18,20 . Furthermore, early diagnosis is related to better prognosis 21 .…”

A Case of Brain Abscess Due to Fusobacterium nucleatum Confused with Intracranial Tumor

“…ESH genelde yükselmiştir (15) . Olgumuzda löko-sitoz, ESH ve ALT yüksekliği vardı, diğer laboratuvar bulgular normaldi.…”

Multiple Brain Abscesses at King Khalid University Hospital

“…This is slightly higher than most reports, which quote a range of 4% to 20% for the incidence of multiple abscesses in brain abscess series. 5,[7][8][9]11 There is, however, one report which stated that up to 35% of brain abscesses may be multiple. 6 The mortality rate in our small series was 33%, which is slightly higher than the 0% to 30% reported as the mortality rate for multiple brain abscesses in series in the post CT scan era.…”

“…It is appreciated that the number of cases reported in our study is small; however, this is not surprising considering that multiple brain abscesses remain a relatively rare disease that has been documented in the international literature either by case reports or small series ranging from seven to 34 cases. [4][5][6][7][8][9][10] It is hoped that the presentation of our cases will heighten the awareness of clinicians about this pathology, which should always be considered in the differential diagnosis of multiple intracranial space-occupying lesions (SOL). In addition, the aim of the paper is to emphasize the importance of early microbiological diagnosis in these patients who still face the risks of a considerable mortality rate.…”