The effect of stereotactic intracavity injection of antibiotics on systemic antibiotics therapy in patients with brain abscess

Abstract

Objective To investigate the feasibility of intracavity administration of high-dose antibiotics to shorten the course of systemic antibiotic therapy. Methods A total of 107 patients with bacterial brain abscesses (155 abscesses) who were treated with stereotactic aspiration and intracavity injection of high-dose antibiotic combined with systemic antibiotic therapy(intracavitary treatment group) at Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center from January 2005 to June 2018 were enrolled in this study. From January 1995 to December 2004, 51 patients with bacterial brain abscesses who were admitted to Department of Neurosurgery, Chinese PLA General Hospital Sixth Medical Center were treated with traditional stereotactic surgery (traditional treatment group). Clinical characteristics, treatment and prognosis in the 2 groups were compared. Results During the follow-up period (mean: 26.2±12.5 months, range: 6-72 months), all the abscesses of the intracavitary treatment group subsided with no recurrence. No adverse effects related to topical use of antibiotics occurred. At the end of follow-up, 78 patients had good outcomes, 21 had mild neurological deficits, 3 had moderate deficits, 1 was in vegetative state, and 4 died of accidents not related to brain abscesses. The course of systemic antibiotic application in the intracavitary treatment group was shorter than that in the traditional treatment group (21.5±2.3 d vs. 36.3±5.2 d, t=25.765, P 0.05). Conclusions Our preliminary results indicated that the local application of antibiotics in brain abscess cavity could reduce the length of time of systemic antibiotic therapy. This treatment could reduce the abscess recurrence rate compared to traditional treatment. Key words: Brain abscess; Stereotactic aspiration; Antibiotics; Route of medication