May short-course intravenous antimicrobial administration be as a standard therapy for bacterial brain abscess treated surgically?

Abstract

OBJECTIVE: To analyze the outcome in subjects with bacterial brain abscesses (BBAs) treated by operation and shorter antimicrobial duration than usual at a single center over a four-year period. METHODS: Retrospective review was conducted on a series of 55 patients with BBAs surgically treated and managed by prospective antimicrobial protocol of shorter antimicrobial duration than usual. Sixty-one abscesses were diagnosed and surgically managed in 55 patients. Open craniotomy excision was the treatment of choice for 58.2% of the patients, whereas 31.8% of the cases were managed through stereotactically guided aspiration. Intravenous antimicrobial agents were given to all patients emipirically or changed later according to culture results. Intravenous antimicrobial administration was discontinued without following oral therapy when the patients' body temperature was continuously normal for 10-14 days after surgery and neuroimaging showed the resolution of BBAs at the same time [Follow-up CT or MRI showed no residue cavity, or the diffusion wedge images (DWI) showed the signal in the residue cavity was as low as the signal of cerebral spinal fluid]. RESULTS: The mean total antimicrobial duration was 21.7 days (10-66 days), and the mean antimicrobial duration after operation was 19.2 days (10-64 days). Follow-up found there were two patients whose BBAs recurred and died 4-5 months after primary BBAs controlled. Follow-up data of the remaining 53 patients were available with a mean follow-up time of 36 months (12-58 months). Outcome was favorable in 65.5% of the subjects. General morbidity was 18.2%, and recurrence and mortality stood at 3.6%, respectively. CONCLUSIONS: This case series showed the short-course intravenous antimicrobial administration can be considered to be a standard therapy for bacterial brain abscess in the surgically treated group, and the thermal curve and DWI are the two paramount indicators that can safely evaluate the antimicrobial times for the treatment of BBAs.