The case records of 49 patients discharged from St George's Hospital, London, between December 2000 and March 2004 with the diagnosis of brain abscess were reviewed in order to document the epidemiology, causes, treatment, and prognostic factors associated with brain abscess. Brain abscess occurred at all ages, more frequently in men than in women. Headache and altered mental status were common presenting symptoms. The frontal lobe was the most common site. Streptococcal infection was seen most commonly, but staphylococcal infection predominated in cases following neurosurgery. Computed tomography provided sufficient diagnostic information in most cases. All but five patients had early surgical drainage. Cefotaxime and metronidazole were used most often for empirical therapy. Thirty-nine patients recovered fully or had minimal incapacity. Five patients died. Patients with underlying cranial neoplasms or medical conditions had a worse outcome than those with a contiguous focus of infection or post-traumatic abscess. Changes in disease pattern were determined by comparison to a literature review. A PubMed search of the literature using the keywords "brain abscess" was undertaken, and identified papers and relevant citations were reviewed. Compared to earlier series, there was a marked decrease in the number of cases of brain abscess secondary to otitis media and congenital heart disease. There was an increase in the number of cases of brain abscess secondary to neurosurgery and trauma. Changes in the epidemiology of predisposing conditions for brain abscess are associated with changes in the patient population and causative organisms. Though still a potentially fatal infection, there have been recent improvements in diagnosis, treatment, and outcome.

BG> or =8 mmol L(-1) predicted elevated AG concentrations in CF, at least in nasal secretions. CFRD patients spent approximately 50% day with BG>airway threshold, implying persistently elevated AG concentrations. Further studies are required to determine whether elevated airway glucose concentrations contribute to accelerated pulmonary decline in CFRD.

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Background: The risk of nosocomial infection is increased in critically ill patients by stress hyperglycaemia. Glucose is not normally detectable in airway secretions but appears as blood glucose levels exceed 6.7-9.7 mmol/l. We hypothesise that the presence of glucose in airway secretions in these patients predisposes to respiratory infection. Methods: An association between glucose in bronchial aspirates and nosocomial respiratory infection was examined in 98 critically ill patients. Patients were included if they were expected to require ventilation for more than 48 hours. Bronchial aspirates were analysed for glucose and sent twice weekly for microbiological analysis and whenever an infection was suspected. Results: Glucose was detected in bronchial aspirates of 58 of the 98 patients. These patients were more likely to have pathogenic bacteria than patients without glucose detected in bronchial aspirates (relative risk 2.4 (95% CI 1.5 to 3.8)). Patients with glucose were much more likely to have methicillin resistant Staphylococcus aureus (MRSA) than those without glucose in bronchial aspirates (relative risk 2.1 (95% CI 1.2 to 3.8)). Patients who became colonised or infected with MRSA had more infiltrates on their chest radiograph (p,0.001), an increased C reactive protein level (p,0.05), and a longer stay in the intensive care unit (p,0.01). Length of stay did not determine which patients acquired MRSA. Conclusion:The results imply a relationship between the presence of glucose in the airway and a risk of colonisation or infection with pathogenic bacteria including MRSA.

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