Spontaneous empyema and brain abscess in an intensive care population: clinical presentation, microbiology, and factors associated with outcome - Scorecard - MDSpire
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Spontaneous empyema and brain abscess in an intensive care population: clinical presentation, microbiology, and factors associated with outcome
Clinical Scorecard: Clinical Characteristics, Microbial Profiles, and Outcome Determinants of Spontaneous Empyema and Brain Abscess in Intensive Care Settings
At a Glance
Category
Detail
Condition
Spontaneous epidural/subdural empyema and pyogenic brain abscess
Key Mechanisms
Intracranial infection leading to abscess formation and empyema, often with bacterial or mixed microbial etiology
Target Population
Critically ill adult patients admitted to Neurocritical Care Unit with spontaneous intracranial empyema or brain abscess
Care Setting
Neurocritical Care Unit in a tertiary hospital intensive care setting
Key Highlights
Incidence of severe intracranial infections is 0.4 to 0.9 per 100,000 per year with mortality of 5–15%.
Most patients were middle-aged males with comorbidities including substance abuse and prior infections.
Favorable outcome (GOSE 5–8) was achieved in 84% of patients; unfavorable outcome associated with older age, decreased consciousness, and shorter symptom-to-admission time.
Guideline-Based Recommendations
Diagnosis
Use radiological, microbiological, and intraoperative verification to confirm diagnosis of empyema or brain abscess.
Assess Glasgow Coma Scale (GCS) and Glasgow Outcome Scale Extended (GOSE) for clinical status and outcome.
Identify infection source where possible, with sinusitis being the most frequent origin.
Management
Initiate neurosurgical interventions and antibiotic therapy promptly; note that nearly half of patients received antibiotics prior to ICU admission.
Consider mechanical ventilation in patients with decreased consciousness or respiratory compromise.
Monitor and treat sepsis according to international consensus definitions.
Monitoring & Follow-up
Follow-up assessment using GOSE at outpatient visits approximately 7 months post-discharge.
Monitor inflammatory markers such as CRP, procalcitonin, and leukocyte count, though these may be normal in some cases.
Evaluate for complications such as cerebral sinus thrombosis, which may worsen outcomes.
Risks
Older age and decreased level of consciousness (GCS < 9) at admission are associated with unfavorable outcomes.
Shorter interval between symptom onset and ICU admission correlates with worse prognosis.
Presence of multifocal abscesses and cerebral sinus thrombosis may increase risk of poor outcome.
Patient & Prescribing Data
Critically ill adults with spontaneous intracranial empyema or brain abscess admitted to Neurocritical Care Unit
Antibiotic therapy often started before ICU admission; microbiological cultures positive in majority despite prior antibiotics; polymicrobial infections common, predominantly gram-positive bacteria and anaerobes.
Clinical Best Practices
Early identification and aggressive management of intracranial infections in ICU settings.
Comprehensive microbiological sampling including abscess material, CSF, and blood cultures even if antibiotics have been initiated.
Close neurological monitoring and timely neurosurgical intervention to reduce morbidity and mortality.
