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Brain abscesses--the Groote Schuur experience, 1993-2003
Kachinga Sichizya1, Graham Fieggen, Allan Taylor
1Department of Neurosurgery, University of Cape Town and Groote Schuur Hospital, Cape Town.
South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
|September 27, 2005
Summary
This study reviewed brain abscess management and outcomes in 121 patients treated surgically at Groote Schuur Hospital. Mortality and morbidity have decreased, with Glasgow Coma Score (GCS) at admission being the key prognostic factor.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Brain abscesses are serious intracranial infections requiring prompt diagnosis and management.
- Surgical intervention is a critical component in treating brain abscesses, alongside antibiotic therapy.
- Understanding management trends and outcomes is crucial for improving patient care.
Purpose of the Study:
- To review the management and outcomes of surgically treated brain abscess patients at Groote Schuur Hospital (GSH) from 1993 to 2003.
- To identify factors influencing patient outcomes and compare current trends with previous studies.
- To assess the effectiveness of diagnostic tools like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in monitoring treatment response.
Main Methods:
- Retrospective review of 121 patients who underwent neurosurgical procedures for brain abscesses between 1993 and 2003.
- Exclusion of patients not treated surgically.
- Utilized computed tomography (CT) scans, ESR, CRP levels, and temperature charts for follow-up and to guide treatment duration and repeat surgical interventions.
Main Results:
- The average patient age was 33 years, with a 5:1 male-to-female ratio. Common symptoms included headache, altered consciousness, and fever. The frontal lobe was the most frequent site, often resulting from trauma.
- Polymicrobial infections were common (50% of identified organisms), with Gram-positive bacteria predominating. Anaerobes were present in 23%. Methicillin-resistant Staphylococcus aureus and Nocardia were identified in a small number of cases.
- Mortality was 13% (16 patients), with lower Glasgow Coma Score (GCS) at admission being a significant predictor of death. Epilepsy developed in 13 patients. Patients received 4 weeks of oral antibiotics post-discharge.
Conclusions:
- Mortality and morbidity associated with brain abscesses have shown a progressive decline compared to earlier studies.
- Glasgow Coma Score (GCS) upon admission remains the most critical prognostic indicator for patient outcomes.
- Continued monitoring with inflammatory markers like ESR and CRP aids in assessing treatment effectiveness and guiding management decisions.