Surgically Treated Community-Acquired Brain Abscess: Bacteriological Analysis Based on Predisposing Infections.

Abstract

Community-acquired brain abscesses are still encountered in clinical practice and cause considerable complications, despite improvements in hygiene in modernized societies. This study aimed to identify potential risk factors pertaining to predisposing infections and microorganisms to facilitate the effective treatment of brain abscesses. Of 121 surgically treated patients with brain abscesses, the most frequent predisposing condition was odontogenic infections (49/121 patients, 40.5%) followed by sinusitis (14/121, 11.6%). Of 121 patients, 51 (42.1%) had no identifiable predisposing infection. Viridans group streptococci (VGS) were the most frequently identified (47%) bacteria in all patients, and anaerobes were more frequently isolated in patients with odontogenic infections (36.7%, p=0.001) than aerobes. Among the patients with no identifiable predisposing infection, the most commonly isolated pathogen was VGS (38.3%); anaerobes occurred significantly less frequently (p=0.045), and old pulmonary tuberculosis was significantly more common (p=0.001) than in the group with identified predisposing infections. There was only one case of staphylococcal infection in 121 patients. The present study indicates that VGS should be the first target for antibiotic treatment when predisposing infections are not identifiable in patients with brain abscesses. Additionally, the association of old tuberculosis with community-acquired brain abscesses is common in these patients.