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Clinical Microbiology and Infection :... Jan 2024These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in...
SCOPE
These European Society of Clinical Microbiology and Infectious Diseases guidelines are intended for clinicians involved in diagnosis and treatment of brain abscess in children and adults.
METHODS
Key questions were developed, and a systematic review was carried out of all studies published since 1 January 1996, using the search terms 'brain abscess' OR 'cerebral abscess' as Mesh terms or text in electronic databases of PubMed, Embase, and the Cochrane registry. The search was updated on 29 September 2022. Exclusion criteria were a sample size <10 patients or publication in non-English language. Extracted data was summarized as narrative reviews and tables. Meta-analysis was carried out using a random effects model and heterogeneity was examined by I tests as well as funnel and Galbraith plots. Risk of bias was assessed using Risk Of Bias in Non-randomised Studies - of Interventions (ROBINS-I) (observational studies) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) (diagnostic studies). The Grading of Recommendations Assessment, Development and Evaluation approach was applied to classify strength of recommendations (strong or conditional) and quality of evidence (high, moderate, low, or very low).
QUESTIONS ADDRESSED BY THE GUIDELINES AND RECOMMENDATIONS
Magnetic resonance imaging is recommended for diagnosis of brain abscess (strong and high). Antimicrobials may be withheld until aspiration or excision of brain abscess in patients without severe disease if neurosurgery can be carried out within reasonable time, preferably within 24 hours (conditional and low). Molecular-based diagnostics are recommended, if available, in patients with negative cultures (conditional and moderate). Aspiration or excision of brain abscess is recommended whenever feasible, except for cases with toxoplasmosis (strong and low). Recommended empirical antimicrobial treatment for community-acquired brain abscess in immuno-competent individuals is a 3rd-generation cephalosporin and metronidazole (strong and moderate) with the addition of trimethoprim-sulfamethoxazole and voriconazole in patients with severe immuno-compromise (conditional and low). Recommended empirical treatment of post-neurosurgical brain abscess is a carbapenem combined with vancomycin or linezolid (conditional and low). The recommended duration of antimicrobial treatment is 6-8 weeks (conditional and low). No recommendation is offered for early transition to oral antimicrobials because of a lack of data, and oral consolidation treatment after ≥6 weeks of intravenous antimicrobials is not routinely recommended (conditional and very low). Adjunctive glucocorticoid treatment is recommended for treatment of severe symptoms because of perifocal oedema or impending herniation (strong and low). Primary prophylaxis with antiepileptics is not recommended (conditional and very low). Research needs are addressed.
Topics: Adult; Child; Humans; Anti-Infective Agents; Brain Abscess; Communicable Diseases
PubMed: 37648062
DOI: 10.1016/j.cmi.2023.08.016 -
Proceedings (Baylor University. Medical... 2024Tumefactive multiple sclerosis (MS) is a subtype of atypical and rare MS that presents with tumor-like lesions in the central nervous system. The lesions may demonstrate...
Tumefactive multiple sclerosis (MS) is a subtype of atypical and rare MS that presents with tumor-like lesions in the central nervous system. The lesions may demonstrate a mass effect, edema, with ring enhancement. They can be mistaken for brain tumors or brain abscesses radiologically and clinically. Here we describe an instructive case of a 55-year-old woman with tumefactive MS who presented with occasional numbness in her right arm and leg, headache, thought confusion, and blurred vision for 2 years.
PubMed: 38343475
DOI: 10.1080/08998280.2023.2289301 -
European Review For Medical and... Oct 2023Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment...
OBJECTIVE
Brain abscess, a localized purulent central nervous system infection, arises from a variety of microorganisms. Expedited diagnosis and formulation of effective treatment strategies are crucial for mitigating mortality risks in patients with brain abscesses. A nuanced understanding of potential microbial agents is pivotal for the development of empirical antibiotic therapies. This study aimed to explore the incidence and microbial etiology of brain abscesses.
PATIENTS AND METHODS
This study is a nationwide cross-sectional analysis of patients diagnosed with brain abscesses in Turkey, employing the ICD 10 diagnosis code from January 1, 2015, to December 31, 2021. Data pertaining to age, sex, comorbidities, and microorganisms isolated from central nervous system samples were meticulously recorded and analyzed.
RESULTS
This study included 11,536 patients diagnosed with brain abscesses. The incidence fluctuated between 0.98 and 3.68 during the review decrease post-2017, with a notable increase in male patients during time. Diabetes constituted 56.5% of the patients. The predominant isolated pathogens were Staphylococcus (37.6%), Streptococci (13.3%), and Klebsiella spp. (7.8%), Escherichia coli (6.4%), and Candida species (6.1%).
CONCLUSIONS
The incidence of brain abscesses is decreasing in Turkey. Although staphylococci remain the most isolated agents, the frequent occurrence of Gram-negative bacteria and Candida species warrants consideration during empirical antibiotic selection.
Topics: Humans; Male; Cross-Sectional Studies; Incidence; Turkey; Anti-Bacterial Agents; Staphylococcus; Brain Abscess; Microbial Sensitivity Tests; Retrospective Studies
PubMed: 37916333
DOI: 10.26355/eurrev_202310_34140