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Diagnosis, management, and outcomes of brain abscess due to gram-negative versus gram-positive bacteria

Cristina Corsini Campioli1, Natalia E Castillo Almeida2, John C O'Horo3

  • 1Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases
|December 13, 2021
PubMed
Abstract

Insights

Brain abscesses caused by gram-negative bacteria (GNB) are linked to prior head and neck surgery. While outcomes were similar, GNB infections showed a higher rate of therapeutic failure compared to gram-positive bacteria (GPB).

Area of Science:

  • Infectious Diseases
  • Neurology
  • Microbiology

Background:

  • Brain abscesses present a significant clinical challenge.
  • Understanding etiological differences between gram-positive bacteria (GPB) and gram-negative bacteria (GNB) is crucial for effective management.
  • Existing data on comparative management and outcomes is limited.

Purpose of the Study:

  • To compare the management and outcomes of brain abscesses caused by monomicrobial infections from GPB versus GNB.
  • To identify risk factors and clinical characteristics associated with each bacterial type.

Main Methods:

  • Retrospective review of adult patients with monomicrobial brain abscesses from 2009-2020.
  • Analysis of patient demographics, medical history, causative pathogens, treatment strategies, and clinical outcomes.
  • Statistical comparison between GPB and GNB groups.

Main Results:

  • 177 patients with monomicrobial brain abscesses: 143 (80.8%) GPB, 34 (19.2%) GNB.
  • GNB group had a higher incidence of prior head/neck surgery (58.8% vs 36.4%, P=0.02).
  • Common GNB pathogens: Pseudomonas aeruginosa, Klebsiella spp., Enterobacter spp. Common GPB pathogens: Staphylococcus aureus, Streptococcus spp. Patients with GNB experienced higher therapeutic failure rates (44.1% vs 22.4%, P=0.01).

Conclusions:

  • Brain abscesses due to GNB are more frequently associated with prior head and neck surgery.
  • No statistically significant differences in infection relapse or 3-month survival were observed between GPB and GNB groups.
  • Patients with GNB brain abscesses demonstrated a higher rate of therapeutic failure.
Keywords:
BacterialBrain abscessDiagnosisGram-negativeGram-positiveManagementOutcomes

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