J Korean Neurosurg Soc.  2014 Jul;56(1):34-41. 10.3340/jkns.2014.56.1.34.

Risk Factors Associated with Poor Outcomes in Patients with Brain Abscesses

• Ko SJ
• Park KJ
• Park DH
• Kang SH
• Park JY
• Chung YG

• KMID: 2067074
• DOI: http://doi.org/10.3340/jkns.2014.56.1.34

Abstract

OBJECTIVE
The purpose of this study was to describe the clinical characteristics, treatment outcomes, and prognostic factors in patients with brain abscesses treated in a single institute during a recent 10-year period.
METHODS
Fifty-one patients with brain abscesses who underwent navigation-assisted abscess aspiration with antibiotic treatment were included in this study. Variable parameters were collected from the patients' medical records and radiological data. A comparison was made between patients with favorable [Glasgow Outcome Scale (GOS) > or =4] and unfavorable (GOS <4) outcomes at discharge. Additionally, we investigated the factors influencing the duration of antibiotic administration.
RESULTS
The study included 41 male and 10 female patients with a mean age of 53 years. At admission, 42 patients (82%) showed either clear or mildly disturbed consciousness (GCS > or =13) and 24 patients (47%) had predisposing factors. The offending microorganisms were identified in 25 patients (49%), and Streptococcus species were the most commonly isolated bacteria (27%). The mean duration of antibiotic administration was 42 days. At discharge, 41 patients had a favorable outcome and 10 had an unfavorable outcome including 8 deaths. The decreased level of consciousness (GCS <13) on admission was likely associated with an unfavorable outcome (p=0.052), and initial hyperglycemia (> or =140 mg/dL) was an independent risk factor for prolonged antibiotic therapy (p=0.032).
CONCLUSION
We found that the level of consciousness at admission was associated with treatment outcomes in patients with brain abscesses. Furthermore, initial hyperglycemia was closely related to the long-term use of antibiotic agents.

Keyword

Brain abscess; Glasgow Coma Scale; Glasgow Outcome Scale; Hyperglycemia

MeSH Terms

Abscess
Bacteria
Brain Abscess*
Causality
Consciousness
Female
Glasgow Coma Scale
Glasgow Outcome Scale
Humans
Hyperglycemia
Male
Medical Records
Risk Factors*
Streptococcus

Figure

• 

  Fig. 1 A: Magnetic resonance image (MRI) of a patient with a 5.9×4.8×5.5 cm brain abscess in the left frontal lobe. The maximum perpendicular diameters (a and b) of the abscess were measured on axial MRIs and the extent in the coronal direction (c) was assessed on coronal or sagittal images. The volume of the abscess was then calculated using the formula: V=abc/2. B: The patient was managed with abscess drainage followed by parenteral antibiotic administration for 6 weeks. MRI at discharge showed a marked decrease in abscess volume and a restoration of mass effect by the abscess.

• 

  Fig. 2 Correlation between the blood glucose level at admission and the duration of antibiotic administration. A significant positive correlation was found between these two factors (r=0.471, p=0.001).

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