Clinical characteristics and prognostic factors of intracranial abscess in regional medical care support hospitals

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  • 地域医療支援病院における細菌性脳膿瘍の臨床的特徴と転帰不良因子の検討
  • チイキ イリョウ シエン ビョウイン ニ オケル サイキンセイ ノウ ノウヨウ ノ リンショウテキ トクチョウ ト テンキ フリョウ インシ ノ ケントウ

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<p>  Although the prognosis of brain abscesses has improved recently, it remains a high‒mortality disease that can lead to severe sequelae. Standard treatment has not been established, and challenges include the selection of antibiotics, indications for surgery, and standardization of surgical procedures. We enrolled patients treated at two general hospitals for a brain abscess between April 2014 and March 2021 and divided them by outcome: the good (modified Rankin Scale [mRS]: 0‒2) and poor (mRS: 3‒6) outcome groups. We retrospectively reviewed clinical features and outcomes and investigated risk factors associated with poor outcomes. Twenty patients’ cases were evaluated: mean age 66.7 ± 15.8 (range, 40‒87) years; 15 males, five females. Fourteen patients (70%) underwent surgery, and the other six were treated with antibiotics without surgery. The causative organisms were identified in 15 patients (75%). Dental and oral infections accounted for most of the presumed causative diseases. Our analyses revealed the following as risk factors associated with poor outcome: a past medical history of cerebrovascular disease, moderate or higher disturbance of consciousness on admission, and complications of ventriculitis. The following were not associated with poor outcome: age, pre‒onset mRS, fever as an initial symptom, white blood cell count and C‒reactive protein levels before treatment, the abscess diameter and location, complications of cerebral herniation and subdural abscess, identification rate of the causative organism, duration of antibiotics, and epilepsy complications. The causative organisms were confirmed in all cases in the early‒surgery patients (who underwent surgery ≤ 72 h after the administration of antibiotics), although this difference between them and the other patients was nonsignificant. Aggressive aspiration can be considered for patients with severe consciousness disturbance and/or high risk of ventriculitis, and it is important to manage the underlying disease and begin rehabilitation from the early hospitalization stage. Since cerebral abscesses caused by dental/oral infections have tended to increase in number in Japan, it is essential to select antibiotics that are sensitive to anaerobic bacteria in empirical antibiotic therapy. The appropriate empirical antibiotic therapy may reduce the sensitivity of causative organisms in surgical specimens, but it should not be expected to have an effect when early surgery is performed.</p>

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