Clinical and Microbiologic Features Guiding Treatment Recommendations for Brain Abscesses in Children

• DOI: 10.1097/inf.0b013e3182748d6e
• Publication Date: 2012-09-21T21:38:08Z
• Authors: Susanna Felsenstein; Bhanu Williams; Delane Shingadia; Lucy Coxon; Andrew Riordan; Andreas K. Demetr...; Christopher L. Ch...; Sanj Bassi; Eirini Koutoumanou; Simon Stapleton; Mike Sharland; Penelope A. Bryant
• Keywords: Brain abscess

There are no guidelines for the management of brain abscesses in children, and there is a paucity recent data describing clinical microbiologic features. We aimed to identify factors affecting outcome inform antibiotic recommendations.From 1999 2009, 118 children presented with 4 neurosurgical centers United Kingdom. Clinical, treatment were collected.The commonest preceding infection was sinusitis, 59% all receiving antibiotics before diagnosis. Nonspecific symptoms common, only 13% having triad fever, headache focal neurological deficit. Time between symptom onset diagnosis varied widely (median, 10 days; range, 0-44). Magnetic resonance imaging more frequently diagnostic than computed tomography. The most frequent organisms Streptococcus milleri (38%), except after penetrating head injury or neurosurgery, which Staphylococcus aureus common. empiric ceftriaxone/cefotaxime metronidazole, offered effective antimicrobial therapy up 83% cases. Metronidazole added benefit maximum 7% cases, alone sufficient at least 76% cases cyanotic congenital heart disease meningitis. A carbapenem would have been 90%. case fatality rate 6% (33% immunocompromised). Long-term sequelae affected 35%. Age younger 5 years Glasgow Coma Scale score ≤8 associated poor 6 months.We recommend metronidazole as treatment, although may be unnecessary many antistaphylococcal cover trauma. Meropenem potentially better choice immunocompromised. prospective study intravenous oral guided by improvement required beause 1-2 weeks during total children.