Evaluation of Brain Abscess Prognostic Factors and Role of Surgical Intervention Within a Single Health System

Abstract

Purpose

Evaluate patient, clinical, and treatment variables impacting mortality in patients with brain abscesses.

Background

Brain abscesses are intraparenchymal infectious foci with significant morbidity and mortality. Management includes antimicrobial therapy +/− surgical intervention, and is dependent on suspected pathogen/source, patient factors, and clinician judgement. Treatment type and duration vary substantially and are often guided by imaging, inflammatory markers, and symptoms.

Methods

186 patients with brain abscesses admitted at a single health system between 2010 and 2022 were analyzed. Patient demographics, clinical course, diagnostic studies, and abscess treatment were assessed for impact on mortality during admission via univariate and stepwise multivariate nominal logistic regression. Secondary outcomes of surgical drainage were evaluated with univariate and multivariate nominal logistic regression, and survival over time of those who received surgical drainage vs those who did not was evaluated with Kaplan-Meier survival analysis.

Results

10.7% of patients died during initial admission. Intravenous drug use, deep-seated abscess location, and surgical complication were independently predictive of death during admission. Patients without surgical intervention demonstrated increased likelihood of mortality over time but not during admission. Independent predictors of surgical intervention include lack of ventriculitis, larger abscess diameter, non-hematogenous or -pulmonary source, and mass effect.

Conclusions

These findings suggest surgical intervention is generally avoided when infection is systemic, severe, or with intraventricular abscess rupture. Patients with overt symptoms of brain infection were more likely to receive prompt surgical drainage. In our patient population, surgical drainage in addition to antimicrobial therapy did not independently impact inpatient mortality although did impact overall survival.