Postneurosurgical nosocomial bacterial brain abscess in adults

Abstract

Background: Bacterial brain abscess after a neurosurgical procedure has become an important occurrence in the hospital setting. However, no information about the frequency, clinical relevance, and the outcome has been reported.

Patients and methods: Over a period of 19 years (1986- 2004), a total of 31 patients were retrospectively identified as having brain abscesses after neurosurgical procedures and were enrolled in this study.

Results: Those included in this study accounted for 0.17% (31/18600) of all neurosurgical procedures in the same period. There was an increased percentage of adult postneurological nosocomial brain abscess compared to all adult bacterial brain abscesses in recent years. The majority of cases were due to Gram-negative bacilli and polymicrobial infections, including both Gram-negative bacilli and Staphylococcus species. Furthermore, the appearance of multi-antibiotic resistant strains was also noted during the study period. The overall fatality rate was 16%.

Conclusion: Post-neurosurgical states have become important predisposing factor for bacterial brain abscess. In patients that undergo neurosurgical procedures and develop smoldering fever, progressively disturbed consciousness, headache, and new onset focal neurologic signs, immediate neuro-imaging studies should be undertaken to determine whether bacterial brain abscess is present. Although mortality may be related to the primary brain pathology, early diagnosis and timely use of appropriate antibiotics based on antimicrobial susceptibility testing are also essential for survival.