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Bodilsen J, Mariager T, Duerlund LS, Storgaard M, Larsen L, Brandt CT, Hansen BR, Wiese L, Omland LH, Nielsen H. Brain Abscess Caused by Oral Cavity Bacteria: A Nationwide, Population-based Cohort Study. Clin Infect Dis 2024; 78:544-553. [PMID: 37946527 DOI: 10.1093/cid/ciad678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/21/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Oral cavity bacteria are the most frequent etiology of brain abscess. Yet, data on the clinical presentation and outcome are scarce. METHODS We performed a nationwide, population-based study comprising all adults (aged ≥18 years) with brain abscess due to oral cavity bacteria in Denmark from 2007 through 2020. Prognostic factors for unfavorable outcome (Glasgow outcome scale, 1-4) were examined using modified Poisson regression to compute adjusted relative risks (RRs) with 95% confidence intervals (CIs). RESULTS Among 287 identified patients, the median age was 58 years (interquartile range, 47-66), and 96 of 287 (33%) were female. Preexisting functional impairment was absent or mild in 253 of 280 (90%), and risk factors for brain abscess included immunocompromise in 95 of 287 (33%), dental infection in 68 of 287 (24%), and ear-nose-throat infection in 33 of 287 (12%). Overall, a neurological deficit was present in 246 of 276 (86%) and in combination with headache and fever in 64 of 287 (22%). Identified microorganisms were primarily the Streptococcus anginosus group, Fusobacterium, Actinomyces, and Aggregatibacter spp., and 117 of 287 (41%) were polymicrobial. Unfavorable outcome occurred in 92 of 246 (37%) at 6 months after discharge and was associated with antibiotics before neurosurgery (RR, 3.28; 95% CI, 1.53-7.04), rupture (RR, 1.89; 95% CI, 1.34-2.65), and immunocompromise (RR, 1.80; 95% CI, 1.29-2.51), but not with specific targeted antibiotic regimens. Identified dental infection was associated with favorable prognosis (RR, 0.58; 95% CI, .36-.93). CONCLUSIONS Brain abscess due to oral cavity bacteria often occurred in previously healthy individuals without predisposing dental infections. Important risk factors for unfavorable outcome were rupture and immunocompromise. However, outcome was not associated with specific antibiotic regimens supporting carbapenem-sparing strategies.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital Aalborg, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital Aalborg, Aalborg, Denmark
| | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital Aalborg, Aalborg, Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | | | | | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, Roskilde, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital Aalborg, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital Aalborg, Aalborg, Denmark
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Bodilsen J, Duerlund LS, Mariager T, Brandt CT, Wiese L, Petersen PT, Larsen L, Hansen BR, Omland LH, Tetens MM, Jørgensen RL, Leth S, Nielsen H. Risk Factors and Prognosis of Epilepsy Following Brain Abscess: A Nationwide Population-Based Cohort Study. Neurology 2023; 100:e1611-e1620. [PMID: 36810235 PMCID: PMC10103119 DOI: 10.1212/wnl.0000000000206866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/13/2022] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epilepsy in patients with brain abscess is frequent but risk factors and prognosis remain undetermined. This study examined risk factors for epilepsy among survivors of brain abscess and associated prognosis. METHODS Nationwide, population-based healthcare registries were used to compute cumulative incidences and cause-specific adjusted hazard rate ratios (adj. HRRs) with 95% confidence intervals (CIs) for epilepsy among 30-day survivors of brain abscess from 1982 through 2016. Data was enriched with clinical details by medical record review of patients hospitalized from 2007 through 2016. Adjusted mortality rate ratios (adj. MRRs) were examined using epilepsy as a time-dependent variable. RESULTS The study included 1,179 30-day survivors of brain abscess among whom 323 (27%) developed new-onset epilepsy after a median of 0.76 years (interquartile range [IQR] 0.24-2.41). At admission for brain abscess, the median age was 46 years (IQR 32-59) in patients with epilepsy compared with 52 years (IQR 33-64) in those without epilepsy. The proportion of females was similar in patients with and without epilepsy (37%). Adj. HRRs for epilepsy were 2.44 (95% CI 1.89-3.15) for aspiration or excision of brain abscess, 2.37 (1.56-3.60) for alcohol abuse, 1.75 (1.27-2.40) for previous neurosurgery or head trauma, 1.62 (1.17-2.25) for stroke, and 1.55 (1.04-2.32) for age group 20-39 years. Cumulative incidences were increased in patients with alcohol abuse (52% vs 31%), aspiration or excision of brain abscess (41% vs. 20%), previous neurosurgery or head trauma (41% vs. 31%), and stroke (46% vs. 31%). Analysis using clinical details from medical record review of patients from 2007 through 2016 demonstrated adj. HRRs of 3.70 (2.24-6.13) for seizures at admission for brain abscess and 1.80 (1.04-3.11) for frontal lobe abscess. In contrast, adj. HRR was 0.42 (0.21-0.86) for occipital lobe abscess.Using the entire registry-based cohort, patients with epilepsy had an adj. MRR of 1.26 (1.01-1.57). DISCUSSION Important risk factors for epilepsy were seizures during admission for brain abscess, neurosurgery, alcoholism, frontal lobe abscess, and stroke. Epilepsy was associated with increased mortality. Anti-epileptic treatment may be guided by individual risk profiles and specialized follow-up is highlighted by increased mortality in survivors with epilepsy.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Malte Mose Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | | | - Steffen Leth
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, 7400 Gødstrup, Denmark.,Institute for Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark.,Institute for Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
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Bodilsen J, Duerlund LS, Mariager T, Brandt CT, Petersen PT, Larsen L, Hansen BR, Omland LH, Tetens MM, Wiese L, Jørgensen RL, Leth S, Nielsen H. Clinical features and prognostic factors in adults with brain abscess. Brain 2022; 146:1637-1647. [PMID: 36037264 DOI: 10.1093/brain/awac312] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/23/2022] [Accepted: 08/15/2022] [Indexed: 11/12/2022] Open
Abstract
Studies on brain abscess are hampered by single-centre design with limited sample size and incomplete follow-up. Thus, robust analyses on clinical prognostic factors remain scarce. This Danish nationwide, population-based cohort study included clinical details of all adults (≥18 years) diagnosed with brain abscess in the Danish National Patient Registry from 2007 through 2014 and the prospective clinical database of the Danish Study Group of Infections of the Brain covering all Danish departments of infectious diseases from 2015 through 2020. All patients were followed for 6 months after discharge. Prognostic factors for mortality at 6 months after discharge were examined by adjusted modified Poisson regression to compute relative risks (RR) with 95% confidence intervals (CI). Among 485 identified cases, the median age was 59 years (IQR 48-67) and 167 (34%) were female. The incidence of brain abscess increased from 0.4 in 2007 to 0.8 per 100,000 adults in 2020. Immuno-compromise was prevalent in 192/485 (40%) and the clinical presentation was predominated by neurological deficits 396/485 (82%), headache 270/411 (66%), and fever 208/382 (54%). The median time from admission until first brain imaging was 4.8 hours (IQR 1.4-27). Underlying conditions included dental infections 91/485 (19%) and ear-nose-throat infections 67/485 (14%), and the most frequent pathogens were oral cavity bacteria (59%), Staphylococcus aureus (6%), and Enterobacteriaceae (3%). Neurosurgical interventions comprised aspiration 356/485 (73%) or excision 7/485 (1%) and was preceded by antibiotics in 377/459 (82%). Fatal outcome increased from 29/485 (6%) at discharge to 56/485 (12%) 6 months thereafter. Adjusted RRs for mortality at 6 months after discharge was 3.48 (95% CI 1.92-6.34) for intraventricular rupture, 2.84 (95% CI 1.45-5.56) for immuno-compromise, 2.18 (95% CI 1.21-3.91) for age >65 years, 1.81 (95% CI 1.00-3.28) for abscess diameter >3 cm, and 0.31 (95% CI 0.16-0.61) for oral cavity bacteria as causative pathogen. Sex, neurosurgical treatment, antibiotics before neurosurgery, and corticosteroids were not associated with mortality. This study suggests that prevention of rupture of brain abscess is crucial. Yet, antibiotics may be withheld until neurosurgery, if planned within a reasonable time period (e.g. 24 hours), in some clinically stable patients. Adjunctive corticosteroids for symptomatic perifocal brain oedema was not associated with increased mortality.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
| | | | - Theis Mariager
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Christian Thomas Brandt
- Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark
| | - Lykke Larsen
- Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark
| | - Birgitte Rønde Hansen
- Department of Infectious Diseases, Hvidovre University Hospital, 2650 Hvidovre, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Malte Mose Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Sjælland University Hospital, 4000 Roskilde, Denmark
| | | | - Steffen Leth
- Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, 7400 Gødstrup, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark.,Institute for Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
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Duerlund LS, Shakar S, Nielsen H, Bodilsen J. Positive Predictive Value of the ICD-10 Diagnosis Code for Long-COVID. Clin Epidemiol 2022; 14:141-148. [PMID: 35177935 PMCID: PMC8843419 DOI: 10.2147/clep.s344515] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/06/2022] [Indexed: 01/22/2023] Open
Abstract
Purpose To examine the positive predictive value (PPV) of International Classification version 10 (ICD-10) diagnosis codes for long coronavirus disease 2019 (long-COVID) in a Danish Health registry. Patients and Methods This was a medical record review of all patients with a diagnosis code of long-COVID (DB948A) at all hospitals in the North Denmark Region from February 27, 2020 through June 30, 2021. Confirmed long-COVID was categorized as fulfillment of all three criteria: (1) a positive polymerase chain reaction (PCR) test for SARS-CoV-2 on a respiratory sample or a positive serum antibody test, (2) symptoms suggestive of long-COVID with no other diagnosis considered more likely, and (3) symptom duration >6 weeks. Results A total of 306 patients were assigned a hospital diagnosis code for long-COVID corresponding to 1.4% of all SARS-CoV-2 positive individuals during the study period (n=21,727). Next, 40 patients were excluded due to incomplete diagnostic evaluation at time of record review leaving 266 patients for analysis. The patients had a median age of 51 years (interquartile range 43–60) and 175/266 (66%) were females. Long-COVID was confirmed in 249/266 yielding an overall PPV of 94% (95%CI: 90–96) and did not differ substantially according to most age groups, sex, previous hospitalization for COVID-19, or by using 12 weeks of symptom duration as cut-off. The PPV was low for children and adolescents (n=5), the very elderly (n=9), and those included by secondary long-COVID diagnoses (n=10). Conclusion The overall PPV of diagnosis codes for long-COVID in the North Denmark Region was high and was likely suitable for future registry-based studies of long-COVID. Caution is advised at the extremes of age and secondary diagnosis codes.
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Affiliation(s)
| | - Shakil Shakar
- The Department of Medicine, Regionshospitalet Nordjylland Hjørring, Hjørring, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Correspondence: Jacob Bodilsen, Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej, 4, Aalborg, 9000, Denmark, Tel +45 97660566, Email
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