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Sahin M, Mert A, Emecen AN, Strunjas NP, Fasanekova L, Batirel A, Darazam IA, Ansari S, Firouzjaei GG, Stebel R, Tigen ET, Sengel BE, Dzupova O, Belitova M, Abid M, Demirbaş ND, Erol S, Kul H, Pekok AU, Ulusoy TÜ, Alay H, Amiri ZM, Cascio A, Karadağ MK, Kolovani E, Mladenov N, Ramosaco E, Sipahi OR, Şanlıdağ G, El-Kholy A, Okay G, Pshenichnaya N, Şahinoğlu MS, Alkan S, Özdemir M, Rahimi BA, Karlidag GE, Balin ŞÖ, Liskova A, Jouhar A, Almajid F, Artur X, Çelik M, Khan A, Lanzafame M, Marıno A, Şenol A, Oncu S, Uğuz M, Zajkowska J, Erdem H. Profiles of primary brain abscesses and their impact on survival: An international ID-IRI study. Int J Infect Dis 2024; 147:107228. [PMID: 39216784 DOI: 10.1016/j.ijid.2024.107228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 08/23/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES This study of 331 primary brain abscess (PBA) patients aimed to understand infecting agents, predisposing factors, and outcomes, with a focus on factors affecting mortality. METHODS Data were collected from 39 centers across 16 countries between January 2010 and December 2022, and clinical, radiological, and microbiological findings, along with their impact on mortality, were analyzed. RESULTS The patients had a mean ± SD age of 46.8 ± 16.3 years, with a male predominance of 71.6%. Common symptoms included headache (77.9%), fever (54.4%), and focal neurological deficits (53.5%). Gram-positive cocci were the predominant pathogens, with Viridans group streptococci identified as the most frequently isolated organisms. All patients received antimicrobial therapy and 71.6% underwent interventional therapies. The 42-day and 180-day survival rates were 91.9% and 86.1%, respectively. Significant predictors of 42-day mortality included intravenous drug addiction (HR: 6.02, 95% CI: 1.38-26.26), malignancy (HR: 3.61, 95% CI: 1.23-10.58), confusion (HR: 2.65, 95% CI: 1.19-5.88), and unidentified bacteria (HR: 4.68, 95% CI: 1.76-12.43). Significant predictors of 180-day mortality included malignancy (HR: 2.70, 95% CI: 1.07-6.81), confusion (HR: 2.14, 95% CI: 1.11-4.15), temporal lobe involvement (HR: 2.10, 95% CI: 1.08-4.08), and unidentified bacteria (HR: 3.02, 95% CI: 1.49-6.15). CONCLUSION The risk of death in PBA extends beyond the infection phase, with different factors influencing the 42-day and 180-day mortality rates. Intravenous drug addiction was associated with early mortality, while temporal lobe involvement was associated with late mortality.
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Affiliation(s)
- Meyha Sahin
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye.
| | - Ali Mert
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University Faculty of Medicine, Istanbul, Türkiye
| | - Ahmet Naci Emecen
- Dokuz Eylul University, Research and Application Hospital, Izmir, Türkiye
| | | | - Lenka Fasanekova
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Istanbul Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Türkiye
| | - Ilad Alavi Darazam
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shabboo Ansari
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazaleh Golchoub Firouzjaei
- Department of Infectious Diseases and Tropical Medicine, Logman Hakim, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roman Stebel
- Department of Infectious Diseases, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Elif Tukenmez Tigen
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Buket Erturk Sengel
- Department of Infectious Diseases and Clinical Microbiology, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Olga Dzupova
- Department of Infectious Diseases, Third Faculty of Medicine, Charles University, University Hospital Bulovka, Prague, Czech Republic
| | - Maya Belitova
- Department of Anaesthesiology and Intensive Care, Medical University-Sofia, University Hospital 'Queen Giovanna' ISUL, EAD, Sofia, Bulgaria
| | - Maha Abid
- Department of Infectious Diseases, Ibn El Jazzar Medical School, Farhat Hached University Hospital, University of Sousse, Sousse, Tunisia
| | - Nazife Duygu Demirbaş
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye
| | - Halil Kul
- Department of Neurosurgery, Ankara City Hospital, Ankara, Türkiye
| | - Abdullah Umut Pekok
- Department of Infectious Diseases of Clinical Microbiology, Istanbul Aydın University Faculty of Medicine, VM Medical Park Pendik Hospital, Istanbul, Türkiye
| | - Tülay Ünver Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Türkiye
| | - Handan Alay
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ataturk University, Erzurum, Türkiye
| | - Zahra Mohtasham Amiri
- Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Mehmet Kürşat Karadağ
- Faculty of Medicine, Department of Neurosurgery, Ataturk University, Erzurum, Türkiye
| | - Entela Kolovani
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | | | - Ergys Ramosaco
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Oğuz Reşat Sipahi
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Türkiye
| | - Gamze Şanlıdağ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Türkiye
| | - Amani El-Kholy
- Faculty of Medicine, Department of Clinical Pathology, Cairo University, Cairo, Egypt
| | - Gulay Okay
- Department of Infectious Diseases and Clinical Microbiology, Bezmi Alem University Faculty of Medicine, Istanbul, Türkiye
| | - Natalia Pshenichnaya
- Department of Infectious Diseases, Central Research Institute of Epidemiology, Moscow, Russia
| | - Mustafa Serhat Şahinoğlu
- Department of Infectious Diseases and Clinical Microbiology, Manisa City Hospital, Manisa, Türkiye
| | - Sevil Alkan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Canakkale Onsekiz Mart University, Canakkale, Türkiye
| | - Mehmet Özdemir
- Department of Microbiology, Necmettin Erbakan University Meram Medical School Hospital, Konya, Türkiye
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Gulden Eser Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | - Şafak Özer Balin
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Firat University, Elazig, Türkiye
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Anas Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - Fahad Almajid
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Xhumari Artur
- Department of Neuroscience, University of Medicine, Service of Neurosurgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Mehmet Çelik
- Department of Infectious Diseases and Clinical Microbiology, Harran University Faculty of Medicine, Sanliurfa, Türkiye
| | | | - Massimiliano Lanzafame
- Unit of Infectious Diseases, Azienda provinciale per i Servizi Sanitari (APSS), Santa Chiara Hospital, Trento, Italy
| | - Andrea Marıno
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Arzu Şenol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Türkiye
| | - Serkan Oncu
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydin, Türkiye
| | - Mustafa Uğuz
- Department of Infectious Diseases and Clinical Microbiology, Mersin City Hospital, Mersin, Türkiye
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University in Białystok, Białystok, Poland
| | - Hakan Erdem
- Gulhane School of Medicine, Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Ankara, Türkiye
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Bodilsen J, D'Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, Montesinos IL, Pagliano P, Sipahi OR, San-Juan R, Tattevin P, Thurnher M, de J Treviño-Rangel R, Brouwer MC. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect 2024; 30:66-89. [PMID: 37648062 DOI: 10.1016/j.cmi.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
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 I2 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.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland.
| | - Quintino Giorgio D'Alessandris
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy; Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | - Mildred A Iro
- Department of Paediatric Infectious diseases and Immunology, The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Matthias Klein
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Hospital of the Ludwig-Maximilians University, Munich, Germany; Emergency Department, Hospital of the Ludwig-Maximilians University, Munich, Germany
| | - Katharina Last
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Inmaculada López Montesinos
- Infectious Disease Service, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Pasquale Pagliano
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, Unit of Infectious Diseases, University of Salerno, Baronissi, Italy; UOC Clinica Infettivologica AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Oğuz Reşat Sipahi
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey; Infectious Diseases Department, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
| | - Rafael San-Juan
- CIBERINFEC ISCIII, CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, 12 de Octubre University Hospital, Madrid, Spain; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections in Compromised Hosts (ESGICH), Basel, Switzerland
| | - Pierre Tattevin
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Majda Thurnher
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rogelio de J Treviño-Rangel
- Faculty of Medicine, Department of Microbiology, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico; European Society of Clinical Microbiology and Infectious Diseases, Fungal Infection Study Group (EFISG), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Antimicrobial Stewardship (ESGAP), Basel, Switzerland; European Society of Clinical Microbiology and Infectious Diseases, Study Group for Genomic and Molecular Diagnostics (ESGMD), Basel, Switzerland
| | - Matthijs C Brouwer
- European Society of Clinical Microbiology and Infectious Diseases, Study Group for Infections of the Brain (ESGIB), Basel, Switzerland; Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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