Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis.
OBJECTIVE
To define clinical characteristics, causative organisms, and outcome, and evaluate trends in epidemiology and outcome of brain abscesses over the past 60 years.


METHODS
We performed a systematic review and meta-analysis of studies on brain abscesses published between 1970 and March 2013. Studies were included if they reported at least 10 patients with brain abscesses, included less than 50% extra-axial CNS infections (empyema) without brain abscess, and did not solely report on brain abscesses caused by a single pathogen.


RESULTS
We identified 123 studies including 9,699 patients reported between 1935 and 2012. There was a male predominance of 2.4 to 1, and the mean age of patients with brain abscesses was 34 years. The most common causative microorganisms were Streptococcus and Staphylococcus species, comprising 2,000 (34%) and 1,076 (18%) of 5,894 cultured bacteria. Geographical distribution of causative microorganisms over continents was similar and did not substantially change over the past 60 years. Predisposing conditions were present in 8,134 of 9,484 patients (86%) and mostly consisted of contiguous or metastatic foci of infection. The classic triad of fever, headache, and focal neurologic deficits was present in 131 of 668 (20%) of patients. Case fatality rate decreased from 40% to 10% over the past 5 decades, while the rate of patients with full recovery increased from 33% to 70%.


CONCLUSIONS
The prognosis of patients with brain abscesses has gradually improved over the past 60 years. Important changes over time were the modality of cranial imaging, neurosurgical technique, and antimicrobial regimen.
From the Departments of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
Matthijs C
MC
Brouwer
Jonathan M
JM
Coutinho
Diederik
D
van de Beek
D001922:Brain Abscess / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D020806:Central Nervous System Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012737:Sex Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000473:pathology*; D013290:Streptococcal Infections / Q000453:epidemiology / Q000473:pathology*; D015996:Survival Rate