Clinical Report: Evolution of Pathogen Profiles in Spontaneous Brain Abscesses
Overview
This 21-year retrospective study of 65 adult patients with spontaneous intracerebral abscesses highlights the predominance of gram-positive cocci, especially Staphylococcus aureus and Streptococcus spp., as causative pathogens. Surgical evacuation combined with prolonged antibiotic therapy resulted in a majority of patients achieving good clinical outcomes, although mortality remained significant.
Background
Intracerebral abscesses and related empyemas are life-threatening conditions with mortality rates around 20%. They often present with neurological symptoms such as headache, nausea, and confusion, with seizures being less common. The causative pathogens vary by infection source, with spontaneous abscesses frequently linked to Streptococcus and Staphylococcus species, while cryptogenic cases constitute nearly half of presentations. Imaging modalities like CT and MRI are essential for diagnosis, and surgical drainage alongside empirical antibiotic regimens remains the cornerstone of treatment.
Data Highlights
Characteristic
Value
Number of spontaneous abscess patients
65
Median age (years)
55 (IQR 36–70)
Gender distribution
29 females (44.6%), 36 males (55.4%)
Surgical treatment
61 open burr hole, 4 needle aspiration
Median IV antibiotic duration
4 weeks (IQR 4–6)
Follow-up available
55 patients
Good outcome (mRS 0–3)
42 patients
Poor outcome (mRS 4–6)
5 patients
In-hospital deaths
8 patients
Common abscess locations
Frontal (38.5%), Parietal (27.7%), Temporal (20%)
Predisposing immunodeficiency factors
Malignancy/chemotherapy (12.3%), polytoxicomania (6.7%), organ transplantation (4.6%)
Spontaneous intracerebral abscesses predominantly affect middle-aged adults with a slight male predominance.
Frontal and parietal lobes are the most common abscess locations.
Gram-positive cocci, especially Staphylococcus aureus and Streptococcus spp., remain the leading pathogens.
Associated infections include sinusitis and odontogenic infections, each accounting for 20% of cases.
Surgical evacuation combined with a median 4-week intravenous antibiotic regimen leads to good outcomes in the majority of patients.
Mortality remains significant at approximately 12%, with neurological sequelae observed in some survivors.
Clinical Implications
Clinicians should maintain a high index of suspicion for spontaneous brain abscesses in patients presenting with neurological symptoms and relevant predisposing infections such as sinusitis or dental infections. Early surgical intervention combined with targeted antibiotic therapy is critical to improve outcomes. Awareness of the predominant pathogens can guide empirical antibiotic choices, emphasizing coverage for gram-positive cocci.
Conclusion
This extensive single-center study underscores the evolving pathogen profile and clinical characteristics of spontaneous intracerebral abscesses. Despite advances in management, timely diagnosis and combined surgical and medical treatment remain essential to optimize patient outcomes.
References
Freiburg Medical Center Study 2000-2021 -- Evolution of Pathogen Profiles in Spontaneous Brain Abscess Development
by Luisa Mona Kraus, Manou Overstijns, Amir El Rahal, Simon Behringer, Klaus-Jürgen Buttler, Lukas Andereggen, Jürgen Beck, Oliver Schnell, Daniel Hornuss, Dirk Wagner, Debora Cipriani
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