The experiences of non-operative treatment in patients with bacterial brain abscess.
Clin Microbiol Infect. 2010 May 18;
Authors: Hsiao SY, Chang WN, Lin WC, Tsai NW, Huang CR, Wang HC, Su CM, Chuang MJ, Lu CH
Abstract Although treatment of brain abscess requires a combination of antimicrobials and surgical intervention for the infected foci, non-surgical, empirical treatment is possible and efficient in selected groups of patients. A total of 31 patients were enrolled in this 22-year retrospective study. We describe our therapeutic experiences and attempt to analyze risk factors that were predictive of therapeutic outcomes. Multiple logistic regression was used to evaluate the relationships between baseline clinical factors and therapeutic outcome during the study period. Of these 31 patients, 25 had community-acquired infections while the other 6 had nosocomially-acquired infections. Thirteen cases (42%) had a single brain abscess and the other 18 cases (58%) had multiple brain abscesses. Furthermore, the association of bacterial meningitis and brain abscess was found in 81% (25/31) of the cases. The overall case fatality rate was 48% (15/31). Significant risk factors for poor outcomes included Glasgow coma scale (GCS) at presentation, presence of septic shock and neck stiffness. In addition, each reduction of one point on the GCS increased the poor outcome rate by 28%. This study demonstrated that both a higher mortality rate (48%) and worse outcomes were found in this select group of patients. Among the significant prognostic factors, a lower mean GCS at presentation was a major determinant of poor outcome.
PMID: 20491832 [PubMed - as supplied by publisher]