Bacterial Brain Abscess: An Outline for Diagnosis and Management

Cristina Corsini Campioli, Natalia E. Castillo Almeida, John C. O'Horo, Zerelda Esquer Garrigos, Walter R. Wilson, Edison Cano, Daniel C. DeSimone, Larry M. Baddour, Jamie J. Van Gompel, Muhammad R Sohail

Research output: Contribution to journalReview articlepeer-review

Abstract

Despite advances in the diagnosis and management of brain abscess, significant associated morbidity and mortality remain high. We retrospectively reviewed adults who presented with pyogenic brain abscess from January 1, 2009, through June 30, 2020. Overall, 247 patients were identified. The median age was 59 years, and 33.6% had a history of head and neck surgery or traumatic brain injury. Diagnostic brain magnetic resonance imaging (MRI) was performed in the bulk (93.1%) of patients. A total of 205 patients (83%) were managed with medical and surgical treatment. The most common definitive antibiotic regimen was monotherapy (48.2%). The median duration of antimicrobial therapy was 42 days. Compared with those who received combined therapy, patients with medical therapy alone had a higher mortality rate (21.4% vs 6%; P =. 003) with more neurologic sequelae (31% vs 27.1%; P = .5). Most patients with brain abscesses are older with multiple underlying comorbidities, and one-third had antecedent head and neck surgery. A prompt combined surgical and medical approach with prolonged antimicrobial therapy may cure the infection with avoidance of permanent residual neurologic deficits.

Original languageEnglish (US)
Pages (from-to)1210-1217.e2
JournalAmerican Journal of Medicine
Volume134
Issue number10
DOIs
StatePublished - Oct 2021

Keywords

  • Bacterial
  • Biopsy
  • Brain abscess
  • Cerebritis
  • Diagnosis
  • Immunocompromised
  • Management
  • Outcomes
  • Stereotactic
  • Surgery

ASJC Scopus subject areas

  • Medicine(all)

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