title: Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses.
abstract: BACKGROUND
  Bacterial brain abscesses remain a serious central nervous system problem despite advances in neurosurgical, neuroimaging, and microbiological techniques and the availability of new antibiotics. The successful treatment of brain abscesses requires surgery, appropriate antibiotic therapy, and eradication of the primary source; nevertheless many controversial issues on the management of this serious infection remain unresolved.
  
  
  OBJECTIVE
  The aim of this GISIG (Gruppo Italiano di Studio sulle Infezioni Gravi) working group - a panel of multidisciplinary experts - was to define recommendations for some controversial issues using an evidence-based and analytical approach. The controversial issues were: (1) Which patients with bacterial brain abscesses can be managed safely using medical treatment alone? (1a) What is the efficacy in terms of outcome, tolerability, cost/efficacy, and quality of life of the different antibiotic regimens used to treat bacterial cerebral abscesses? (1b) Which antibiotics have the best pharmacokinetics and/or tissue penetration of brain and/or brain abscess? 2) What is the best surgical approach in terms of outcome in managing bacterial brain abscesses? Results are presented and discussed in detail.
  
  
  METHODS
  A systematic literature search using the MEDLINE database for the period 1988 to 2008 of randomized controlled trials and/or non-randomized studies was performed. A matrix was created to extract evidence from original studies using the CONSORT method to evaluate randomized clinical trials and the Newcastle-Ottawa Quality Assessment Scale for case-control studies, longitudinal cohorts, and retrospective studies. The GRADE method for grading quality of evidence and strength of recommendation was applied.
authors.affiliation: Department of Internal Medicine I, Infectious Diseases Unit Infermi Hospital, Italy. arlotti.massimo@gmail.com
authors.forename: Massimo
authors.initials: M
authors.lastname: Arlotti
authors.forename: Paolo
authors.initials: P
authors.lastname: Grossi
authors.forename: Federico
authors.initials: F
authors.lastname: Pea
authors.forename: Giustino
authors.initials: G
authors.lastname: Tomei
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Vullo
authors.forename: Francesco G
authors.initials: FG
authors.lastname: De Rosa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Perri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicastri
authors.forename: Francesco N
authors.initials: FN
authors.lastname: Lauria
authors.forename: Giampiero
authors.initials: G
authors.lastname: Carosi
authors.forename: Mauro
authors.initials: M
authors.lastname: Moroni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D001922:Brain Abscess / Q000188:drug therapy* / Q000382:microbiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents