Pyogenic brain abscess and subdural empyema: presentation, management, and factors predicting outcome

Area of Science:

• Neurology
• Infectious Diseases
• Neurosurgery

Background:

• Bacterial brain abscess and subdural empyema are serious intracranial infections.
• Effective management requires a multidisciplinary approach involving neurosurgery and infectious disease specialists.

Purpose of the Study:

• To describe the clinical presentation and management of bacterial brain abscess and subdural empyema.
• To identify predictors of poor clinical outcomes in affected adults.

Main Methods:

• Retrospective analysis of clinical records from two tertiary centers.
• Multivariate regression analysis to identify factors associated with outcomes.

Main Results:

• 113 adult patients were analyzed, with varied presentations including focal neurological deficits and reduced Glasgow Coma Scale (GCS).
• Common causes included contiguous infections and hematogenous spread; Streptococci, Staphylococci, and anaerobes were frequently isolated.
• Treatment involved prolonged antibiotics and neurosurgical drainage, with 5% mortality and 31% long-term disability. Reduced GCS, focal deficits, and seizures predicted adverse outcomes.

Conclusions:

• Complex surgical and antimicrobial strategies lead to good outcomes in most cases of bacterial brain abscess and subdural empyema.
• Predictive factors at diagnosis can identify patients at risk of adverse outcomes.
• Further research into optimal surgical and antibiotic management is warranted.