Community-acquired intracranial suppurative infections: 15-year report

Abstract

Results Of all 23 patients, mean age was 38.21 ± 12.61 (range: 19-67 years, median: 34) and mean duration of symptoms was 22.25 ± 20.22 days. Seventeen(73.39 %) patients were male. Headache was the most common symptom. Frontal lobe was the most common localization of ISI and mastoiditis due to chronic suppurative otitis media was the most common source of infection causing to ISI. Invasive procedure was undergone to 16 (69.5%) cases as open craniotomy, burrhole aspiration and stereotactic biopsy to due to severity of signs and symptoms at admission, deteriorating clinical findings and convulsion. P. mirabilis, Pseudomonas spp. , Peptostreptococcus spp. , Enterococcus avium, M. tuberculosis complex and Toxoplasma gondii were isolated from specimens of six cases (37,5 %) among 16 cases that have undergone to open craniotomy (n:2), burrhole aspiration (n:12) and stereotactic biopsy (n:2). Leukocytosis was observed in 13 patients (11,527 ± 4,552). Ceftriaxone (2 gr IV every 12 hours) combined with metronidazole (500 mg IV every 8 hours) were given to patients between 21 and 120 days until clinical signs and resolution of radiological findings recovered. Initial standard treatment was switched to combination therapy including vancomycin and meropenem in five patients and to meropenem therapy in two cases for two weeks due to severity of symptoms at admission and deterioration of signs and symptoms under standard combination therapy. Sequelae and case fatality rates were observed as 8.6%. Relapse did not occur.