Abstract

PURPOSE
Brain abscess (BA) and subdural empyema (SDE) are uncommon but clinically important conditions in childhood. Treatment involves surgery and prolonged courses of antibiotics. There is no consensus on the optimal approach. The objective was to review management and outcome of BA and SDE in a single UK center.
METHODS
This retrospective case notes review of children with brain abscess or subdural empyema admitted to a tertiary pediatric infectious diseases and neurosurgical center from 2001 to 2009.
RESULTS
Forty-two children were included in the study; 17 children were with BA, 23 with SDE, and two both with BA and SDE. The causative factors found in 88 % of the patients were most commonly sinusitis and meningitis with congenital heart disease and immunocompromise unusual. Streptococcus anginosus group organisms were most common; 10 % of the children had a resistant pathogen and 86 % had surgical intervention. Fifteen patients with BA underwent surgery; nine of these patients underwent burrhole aspiration, three had craniotomy, two had stereotactic surgery, and one had endoscopic aspiration. Remaining 19 patients with SDE underwent surgery: seven had burrhole aspiration, 11 underwent craniotomy, and one had aspiration via the anterior fontanel. The most common antibiotic regime was cefotaxime, metronidazole, and amoxicillin. Mean duration of treatment was 14.4 weeks. Mean time until normalization of C reactive protein was 23 days. Survival was 95 % and 20 % had ongoing neurological sequelae.
CONCLUSIONS
BA and SDE remain important childhood infections in the UK. Antibiotics are essential in the management of these cases. Empiric antibiotic choices require knowledge of likely pathogens and local resistance. Selected infections can be treated without surgical intervention. Long courses of antibiotics were administered. Outcome is good, and neurological sequelae were less common than found in previous series.

Links

Publisher Full Text

Authors

Cole TS, Clark ME, Jenkins AJ, Clark JE

Institution

Institute of Cellular Medicine, Newcastle University, Newcastle, UK. theresa.cole@ncl.ac.uk

Source

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 28:12 2012 Dec pg 2109-14

MeSH

Adolescent
Anti-Bacterial Agents
Brain
Brain Abscess
C-Reactive Protein
Central Nervous System Bacterial Infections
Child
Child, Preschool
Data Collection
Data Interpretation, Statistical
Databases, Factual
Empyema, Subdural
Female
Great Britain
Humans
Immunocompromised Host
Infant
Infant, Newborn
Male
Meningitis
Neurosurgical Procedures
Retrospective Studies
Seizures
Sinusitis
Suppuration
Survival Analysis

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22864509