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Abstract Details

Outcome Comparison of Antibiotics-only Versus Antibiotics and Surgical Drainage in Brain Abscesses
Infectious Disease
P8 - Poster Session 8 (5:30 PM-6:30 PM)
13-002
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. 
Compare outcomes with antibiotics only versus antibiotics and surgical drainage in patients admitted with brain abscess. 
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. 
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. 
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.
Authors/Disclosures
Jamie Cronin
PRESENTER
Ms. Cronin has nothing to disclose.
Timothy Ung (University of Colorado) No disclosure on file
Amanda L. Piquet, MD, FAAN (University of Colorado) The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. The institution of Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for UCB. The institution of Dr. Piquet has received personal compensation in the range of $0-$499 for serving as a Consultant for EMD Serono. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Piquet has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Sands Anderson PC. Dr. Piquet has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Joe Jones Law Firm. The institution of Dr. Piquet has received research support from Rocky Mountain MS Center. The institution of Dr. Piquet has received research support from Novartis. The institution of Dr. Piquet has received research support from Abbvie. The institution of Dr. Piquet has received research support from Roche/Genentech. The institution of Dr. Piquet has received research support from NYU. The institution of Dr. Piquet has received research support from Anokion. The institution of Dr. Piquet has received research support from UCB . The institution of Dr. Piquet has received research support from Foundation for Sarcoidosis. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received publishing royalties from a publication relating to health care. Dr. Piquet has received personal compensation in the range of $10,000-$49,999 for serving as a Litigative Consultant with US-Dept HHS/DICP. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Autoimmune Encephalitis Alliance (AEA) that is relevant to AAN interests or activities. Dr. Piquet has a non-compensated relationship as a Medical Advisory Board Member with Stiff Person Syndrome Research Foundation (SPSRF) that is relevant to AAN interests or activities.
Kelli Money, MD, PhD (UCHealth Neurology Clinic- Memorial Hospital North) Dr. Money has nothing to disclose.