دورية أكاديمية
Clinical features and prognostic factors in adults with brain abscess.
| العنوان: | Clinical features and prognostic factors in adults with brain abscess. |
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| المؤلفون: | Bodilsen J; Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark., Duerlund LS; Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark., Mariager T; Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark., Brandt CT; Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark., Petersen PT; Department of Pulmonary- and Infectious Diseases, Nordsjællands Hospital, 3400 Hillerød, Denmark., Larsen L; Department of Infectious Diseases, Odense University Hospital, 5000 Odense, Denmark., Hansen BR; Department of Infectious Diseases, Hvidovre University Hospital, 2650 Hvidovre, Denmark., Omland LH; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark., Tetens MM; Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark., Wiese L; Department of Infectious Diseases, Sjælland University Hospital, 4000 Roskilde, Denmark., Jørgensen RL; Department of Neurosurgery, Aarhus University Hospital, Skejby, 8200 Aarhus N, Denmark., Leth S; Department of Infectious Diseases, Aarhus University Hospital, 8200 Aarhus N, Denmark.; Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, 7400 Gødstrup, Denmark., Nielsen H; Department of Infectious Diseases, Aalborg University Hospital, 9000 Aalborg, Denmark.; Institute for Clinical Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark. |
| مؤلفون مشاركون: | DASGIB study group |
| المصدر: | Brain : a journal of neurology [Brain] 2023 Apr 19; Vol. 146 (4), pp. 1637-1647. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Oxford University Press Country of Publication: England NLM ID: 0372537 Publication Model: Print Cited Medium: Internet ISSN: 1460-2156 (Electronic) Linking ISSN: 00068950 NLM ISO Abbreviation: Brain Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Oxford : Oxford University Press Original Publication: London. |
| مواضيع طبية MeSH: | Brain Abscess*/diagnosis , Brain Abscess*/drug therapy, Humans ; Adult ; Female ; Middle Aged ; Aged ; Male ; Cohort Studies ; Prognosis ; Prospective Studies ; Anti-Bacterial Agents/therapeutic use |
| مستخلص: | 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 with 95% confidence intervals (CI). Among 485 identified cases, the median age was 59 years [interquartile range (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 h (IQR 1.4-27). Underlying conditions included dental infections 91/485 (19%) and ear, nose and 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 relative risks 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 immunocompromise, 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 h), in some clinically stable patients. Adjunctive corticosteroids for symptomatic perifocal brain oedema was not associated with increased mortality. (© The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.) |
| فهرسة مساهمة: | Investigator: M Storgaard; L Larsen; BR Hansen; CØ Andersen; L Wiese; CT Brandt; J Helweg-Larsen; HR von Lüttichau; H Nielsen; J Bodilsen Keywords: brain abscess; cerebral abscess; microbiology; prognosis; treatment |
| المشرفين على المادة: | 0 (Anti-Bacterial Agents) |
| تواريخ الأحداث: | Date Created: 20220829 Date Completed: 20230421 Latest Revision: 20230427 |
| رمز التحديث: | 20230428 |
| DOI: | 10.1093/brain/awac312 |
| PMID: | 36037264 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1460-2156 |
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| DOI: | 10.1093/brain/awac312 |