Retrospective Review of the Clinical Outcomes of Surgically Managed Patients with Intracranial Abscesses: A Single-Center Review

European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults

“…A nationwide and population-based cohort study of 485 Danish adults with brain abscess found that deferral of antibiotics until aspiration or excision was not associated with increased 6-month risks of mortality (relative risk (RR) 0.79 [95% CI 0.42e1.52]) or unfavourable outcome (RR 1.15 [95% CI 0.87e1.52]) in adjusted analyses [22]. Another recent Canadian study of 139 patients observed an unfavourable outcome in 33 of 123 (27%) if antimicrobials were initiated before aspiration or excision of brain abscess compared with 2 of 16 (13%) if antimicrobial treatment was deferred until neurosurgery (p 0.25) [18].…”

“…A total of 13 studies were considered of relevance for this key question. Unfavourable outcome according to different outcome scale scores was accepted as proxies for neurological deficits in four reports yielding a total of nine studies with data available for the meta-analyses (Table S16) [18,20,38,84,89,122,125,129,141]. They were all retrospective cohort studies, eight included children, one was multi centre, and one was population based.…”

“…No studies quantified symptom relief from corticosteroid therapy in patients with brain abscess and perifocal oedema. Risk of neurological deficits was examined in seven studies and was found to be 90 of 303 (30%) in patients treated with corticosteroids compared with 80 of 383 (21%) among those not treated with corticosteroids (p 0.01) (Table S17) [18,20,38,89,122,129,141]. This yielded an OR for neurological deficits of 0.7 (95% CI 0.5e1.0) in favour of no adjunctive corticosteroid treatment (Figs.…”