Multiple brain abscesses in a premature infant: complication of Staphylococcus aureus sepsis

Abstract

We report a premature infant with Staphylococcus aureus sepsis, most probably originating from an infected peripheral iv site, and complicated by multiple brain abscesses. Diagnosis was made by cranial ultrasonography and computed tomography. Since systemic antibiotic treatment failed, surgical drainage was performed. The same organism that caused the initial sepsis grew from the pyogenic material obtained. The child is currently severely handicapped.

A Long‐Term Survey of Methicillin‐Resistant Staphylococcus aureus in the Oral Cavity of Children

“…Staphylococcus aureus is the most common pathogen in various infectious diseases such as impetigo (5), pneumonia (12, 27) and sepsis (26). In the oral area, S. aureus causes osteomyelitis and alveolar abscesses (28,29).…”

Combination of drainage and chemotherapy for treatment of a Staphylococcus aureus brain abscess in a pre-term infant

“…This did not prevent abscess formation, in spite of the facilitated diffusion of vancomycin through the inflamed haematoencephalic barrier (Tunkel et al, 2004;García-Sánchez et al, 1993), thus indicating that the physiological immaturity of the immune system makes pre-term neonates especially susceptible to infection, even when treated adequately. However, our patient and the one described by Vartzelis et al (2005) were subjected to early abscess drainage to lower intracranial pressure, while it seems that drainage in the case reported in Regev et al (1995) was done later as a consequence of antibiotic treatment failure, while no indication on whether this was performed at all was provided by Arora et al (2012). Interestingly, no neurological or developmental sequelae were observed in the two first children (Vartzelis et al, 2005 and this study), which contrasts with the psychomotor retardation reported in the third case (Regev et al, 1995) and the lack of reference to the outcome for the fourth child (Arora et al, 2012).…”

“…In these cases, it appears that the brain became infected through the haematogenous route during the sepsis, because culture of the cerebrospinal fluid remained negative in all cases, while identical strains were obtained from the blood during sepsis and from the brain abscess drainages. The main difference between the case described by Vartzelis et al (2005) and the others (Regev et al, 1995;Arora et al, 2012), including our own, is that in the first instance the treatment of the previous sepsis was performed empirically with ampicillin plus gentamicin, while in the others vancomycin was used. It turned out that the causative staphylococcal strain of the first report was resistant to this b-lactam antibiotic, whereas the strains isolated from the other cases were susceptible to the glycopeptide.…”

“…Thus, in older children they are often recognized by the presence of a higher intracranial pressure, while in neonates the fontanelles and the cranial sutures are still open and an intracranial mass lesion can grow without raising the intracranial pressure (de Oliveira et al, 2007). Of these infections, staphylococcal brain abscesses are rare entities in young infants and, to the best of our knowledge, only three have been reported previously as secondary to sepsis (Vartzelis et al, 2005;Regev et al, 1995;Arora et al, 2012). In these cases, it appears that the brain became infected through the haematogenous route during the sepsis, because culture of the cerebrospinal fluid remained negative in all cases, while identical strains were obtained from the blood during sepsis and from the brain abscess drainages.…”

“…The most common aetiological agents are: Citrobacter spp., Pseudomonas aeruginosa and enterobacteria such as Proteus mirabilis and Serratia marcescens (Azrak et al, 2009;Krajewski & Stelmasiak, 1992). In contrast, Staphylococcus aureus rarely causes brain abscesses during the first months of life (Arora et al, 2012;de Oliveira et al, 2007;Regev et al, 1995;Vartzelis et al, 2005). In this report, we present the clinical features, treatment and outcome of a premature infant with multiple brain abscesses caused by S. aureus.…”