1. Brain abscess in children, a two-centre audit: outcomes and controversies.
- Author
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Gilard V, Beccaria K, Hartley JC, Blanot S, Marqué S, Bourgeois M, Puget S, Thompson D, Zerah M, and Tisdall M
- Subjects
- Anti-Bacterial Agents therapeutic use, Brain Abscess diagnosis, Brain Abscess drug therapy, Child, Child, Preschool, Humans, Infant, Infant, Newborn, London, Medical Audit, Meningitis, Bacterial complications, Meningitis, Bacterial diagnosis, Meningitis, Bacterial drug therapy, Otorhinolaryngologic Diseases complications, Otorhinolaryngologic Diseases diagnosis, Paris, Retrospective Studies, Staphylococcal Infections diagnosis, Staphylococcal Infections drug therapy, Streptococcal Infections diagnosis, Streptococcal Infections drug therapy, Treatment Outcome, Brain Abscess surgery
- Abstract
Objective: The aim of this study was to better characterise clinical presentation, management and outcome in infants and children with brain abscess., Methods: The authors conducted a retrospective, multicentre study in two national reference centres over a 25-year period (1992-2017). During this period, 116 children and 28 infants (age <1 year) with brain abscess were treated., Results: The median age at diagnosis was 101.5 (range: 13-213) months in children and 1 (0-11) month in infants. Significant differences were observed between children and infants. The most common predisposing factor was meningitis in infants (64% of cases vs 3% in children), while it was otolaryngology-related infection in children (31% of cases vs 3.6% in infants). Infants presented more frequently with fever and meningism compared with children. 115 patients were treated with aspiration and 11 with excision. Reoperation was required in 29 children vs 1 infant. The overall mortality rate was 4% (3.4% for children, 7.1% for infants). At 3-month follow-up, the outcome was favourable in 86% of children vs in 68% of infants., Conclusion: There is a clear difference between children and infants with brain abscess in terms of predisposing factors, causative organisms and outcome. Despite surgical drainage and directed antibiotic therapy, 25% of patients with brain abscess require reoperation. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2020
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