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Bacteriology of abscesses of the central nervous system: a multicentre prospective study
Abstract:
Pus from 46 patients with abscesses of the central nervous system (CNS) was examined for bacteria; bacteria were found in all patients. Streptococci were isolated from 36 patients and most isolates were Streptococcus milleri, Lancefield Group F, Ottens and Winkler type O III. Staphylococci were isolated from nine patients, organisms of the bacteroides group from 11, Proteus spp from seven, Klebsiella aerogenes from one, and Haemophilus aphrophilus from one. Pure cultures predominated over mixed cultures. Streptococci were isolated from abscesses of all types, and at all sites, but members of the Enterobacteriaceae and of the bacteroides group were isolated, in mixed cultures, principally from abscesses of the temporal lobe secondary to infection of the middle ear. Staphylococci predominated in abscesses that followed accidental or surgical trauma. Compared with fully sensitive control organisms, microbes infecting half the patients were resistant to penicillin. The prognosis of abscess of the CNS is grave, and the microbiological findings have important consequences for treatment. Prompt inoculation of specimens to culture plates and prompt incubation are mandatory if bacteria are to be cultured. Inhibitors of antimicrobial agents should be added to culture media if antibiotics have been administered. Provided that the site of the abscess and the antecedent history are ascertainable, the neurosurgeon should be able to start appropriate treatment while awaiting the results of culture.
Insights
Bacterial infections cause central nervous system (CNS) abscesses in all patients. Streptococcus milleri was the most common pathogen, with half of microbes showing penicillin resistance, impacting treatment strategies.
Area of Science:
- Neurology
- Microbiology
- Infectious Diseases
Background:
- Central nervous system (CNS) abscesses are serious infections requiring prompt diagnosis and treatment.
- Understanding the causative microorganisms is crucial for effective therapeutic interventions.
Purpose of the Study:
- To identify the bacteria responsible for CNS abscesses in a cohort of patients.
- To correlate microbial findings with abscess characteristics and patient outcomes.
Main Methods:
- Analysis of bacterial cultures from pus samples of 46 patients diagnosed with CNS abscesses.
- Identification of bacterial species and assessment of antimicrobial susceptibility, particularly to penicillin.
Main Results:
- Bacteria were detected in all CNS abscesses; Streptococcus milleri was the most frequently isolated organism.
- Mixed bacterial cultures, including Enterobacteriaceae and Bacteroides, were common in temporal lobe abscesses.
- Staphylococci predominated in abscesses linked to trauma. Notably, 50% of isolates exhibited penicillin resistance.
Conclusions:
- Microbiological analysis of CNS abscesses reveals diverse bacterial etiologies with significant implications for treatment.
- The high prevalence of penicillin resistance underscores the need for susceptibility testing and tailored antibiotic regimens.
- Prompt microbiological investigation and consideration of clinical history are vital for guiding neurosurgical and antimicrobial therapy.