Objective:

Compare outcomes with antibiotics only versus antibiotics and surgical drainage in patients admitted with brain abscess. 

Background:

Brain abscesses are suppurative intraparenchymal foci of infection secondary to bacterial, viral, or fungal pathogens with significant associated morbidity and mortality. Management includes antimicrobial therapy with or without surgical intervention, with choice of therapy dependent on suspected pathogen source, patient factors, and clinician judgement. Type and duration of treatment vary substantially and are often guided by surveillance imaging, inflammatory markers, and reported symptoms. 

Design/Methods:

186 patients with brain abscesses treated within a single health system between 2010-2023 were analyzed. Patient demographics, lab/imaging studies, and abscess treatment regimen were assessed for impact on patient mortality during admission via univariate and stepwise multivariate logistic regression. Multivariate regression was also utilized to evaluate predictive factors for surgical drainage of brain abscess. 

Results:

Those without ventriculitis or presenting with pulmonary/hematogenous source or midline shift were more likely to receive abscess surgical drainage. Headache at admission, unknown pathogen source, fungal organism, juxtaventricular abscess, and abscess not surgically drained during admission were only dependent predictors of inpatient death. Intravenous drug use, deep-seated abscess location, ventriculitis, and surgical complication were independently predictive of death during initial admission. 

Conclusions:

These findings suggest surgical drainage is generally not performed when infection is systemic or with intraventricular abscess rupture. Drainage was also avoided in patients with more severe infections. Reduced instances of mortality with identified pathogen supports critical need for brain abscess culture when no microorganism is systemically identified. In our patient population, surgical drainage in addition to antimicrobial therapy did not independently impact risk of inpatient death when compared to antimicrobial therapy alone, and any surgical complications increased likelihood of death during initial admission.