Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea

Abstract

Background Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess. Methods A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up. Results The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes. Conclusions Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.

Brain Abscess Due to Lactobacillus Fermentum in an Uncontrolled Diabetic

“…Uncommonly, Lactobacillus species can be pathogenic, resulting in bacteremia, endocarditis, dental abscesses, meningitis, liver abscess, and other intra-abdominal infections [9][10][11]. There are sparse case reports where Lactobacillus species are isolated from brain tissue, with a possible odontogenic primary source, however, these reports found Lactobacillus catenaformis and not Lactobacillus fermentum, which was isolated from our patient [4][5][6].…”

“…It is a catalase-negative, Gram-positive rod, and facultative anaerobic bacteria that can be found as a commensal organism in the gastrointestinal tract, genitourinary tract, and the oral cavity. There are rare case reports where the pathogen is isolated from brain tissue with a possible odontogenic primary source [4][5][6]. We present a case of a middle-aged woman with uncontrolled diabetes who had Lactobacillus fermentum isolated from a left parietal lobe brain abscess in the absence of bacteremia or a clear source of infection.…”

Clinical and radiological characteristics of brain abscess due to different organisms in hospitalized patients: A 6-year retrospective study from China

“…Previous studies have reported some other prognostic factors for BA. Cho et al reported that higher Sequential Organ Failure Assessment, pre-existing hemiplegia, and higher Charlson comorbidity index were associated with unfavorable clinical outcomes [ 10 ]. Widdrington et al reported that a reduced Glasgow coma scale (GCS) (OR, 16.6; 95% CI, 5.63–48.93; P < 0.001), focal neurological deficit (OR, 5.50; 95% CI, 1.67–18.08; P = 0.003), and seizures (OR, 3.68; 95% CI, 1.26–10.78; P = 0.014) at presentation were independently associated with an unfavorable clinical outcome (death or disability) [ 17 ].…”

“…BAs are usually caused by bacteria, although can also be caused by other pathogens including fungi and protozoa, and sometimes polymicrobial infection should be considered [ 7 ]. The causative pathogens of bacterial BAs vary according to geographic location, age, underlying medical conditions, and mode of infection [ [8] , [9] , [10] ]. A meta-analysis of cohort studies summarised data of 9699 patients from 123 studies and showed that the most common causative microorganisms were Streptococcus (34%) and Staphylococcus species (18%) [ 11 ].…”

Brain abscess in immunocompetent patients: recent findings

“…A recent retrospective cohort study examined patients with brain abscesses recruited from May 2005 to December 2018 in South Korea. This study showed that risk factors for mortality were higher Sequential Organ Failure Assessment (SOFA) [OR 1.52, 95% CI (1.21–1.92)], preexisting hemiplegia [OR 7.65, 95% CI (1.85–68.92)], and a higher CCI [OR 1.28, 95% CI (1.03–1.59)] [49].…”