Survival outcomes and prognostic factors of fungal brain abscess: A comparative cohort study

Brain abscess (BA) is a life-threatening intracranial infection. While bacterial BA has been extensively studied, the prognostic impact of fungal BA remains uncertain. This study aimed to compare survival outcomes between fungal and bacterial BA and to identify independent prognostic factors.

We used a retrospective cohort study of patients with BA in a tertiary care center in southern Thailand. The classification of patients as fungal or bacterial BA was made by microbiological or pathological confirmation. Kaplan-Meier analysis and Cox proportional hazards were used to analyze survival. The continuous predictors were also analyzed with restricted cubic spline models to determine the dose-response relationship.

A total of 186 patients were included (161 bacterial, 25 fungal). Fungal BA patients were very poor in terms of survival compared to bacterial BA (log-rank p < 0.001). Fungal BA was still an independent predictor of mortality after multivariate adjustment of clinical and radiological factors (HR 15.53; 95%CI 1.48-162.44; p = 0.02). The relationship between preoperative blood glucose and mortality demonstrated a relationship of a U-shaped pattern, with the highest risk observed at the low and high levels.

The mortality of fungal BA is significantly higher than that of bacterial BA. Such outcomes emphasize the importance of early diagnosis, timely microbiological diagnosis, and optimal perioperative metabolic treatment to enhance the outcome.