43. Prognosis of Brain Abscesses : Interest of Antibiotics Oral Switch. A Single Center Cohort Study of 109 Adult Patients.
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • Prognosis of Brain Abscesses.pdf (779.6 kB)
  • Background:

    Brain abscess remains a serious central nervous system infection, potentially responsible of death or heavy neurologic sequelae, so clinical issues as surgical or antibiotics are crucial. We aimed to describe clinical management and prognostic factors in order to improve therapeutics options.

    Methods:

    Adult patients hospitalized from march 2003 to december 2016 for brain abcess were retrospectively included. Infections caused by mycobacteria, fungi or parasites were excluded. Comorbities (Charlson score), initial presentation (Glasgow coma scale -GSC, number and size of abscess, ICU admission, microbiology), medical and surgical treatment were collected. Outcome was defined according to the Glasgow outcome scale (GOS) : unfavorable (death, vegetative status, or severe disability) vs favorable (moderate disability or god recovery). Multivariate logistic regression was used to determine factors independently associated with outcome.

    Results:

    109 adults patients were included, 80 males (73,4%), mean age 58 years (std 16,5 years), most frequently presenting with fever (68,8%), headache (54,1%), and focal neurologic deficits (42,2%). Initial GCS was less than 15 in 49,5%. Bacteria were identified for 63,3% of patients and polymicrobial infections occurred in 31 (28,4%) patients. Identified species were streptococci (29,4%), anaerobic bacteria (26,6%), Methicillin-susceptible Staphylococcus aureus (14,4%), 3 nocardiosis and 5 actinomycosis. 81 patients (74,3%) underwent surgery while 25,7% received medical treatment alone.

    The antimicrobials used were beta-lactams (94,5%), nitroimidazoles (54,2%), fluoroquinolones (45,9%), chloramphenicol (43,1%) and rifampicin (30,2%) : 98,2% were initially intravenous, 45% were switched to oral way, and total median duration was 65 days (IQ 45-95). Mortality rate 3 months after diagnosis was 12% (n= 13).

    In multivariate logistic regression, abnormal GCS (OR, 4,5 ; P = .008) and comorbidities (OR, 4,6 ; P = .027) were associated with unfavorable outcome, while better outcome was observed in patients with oral antibiotic switch (OR, 0,14 ; P = .013).

    Conclusion:

    This result may incite physicians to oral switch in management of brain abscess. Oral antibiotic therapy can mean reduced hospital costs, shorter hospital stay, and a higher quality of life for patients.

    Antoine Khati, Resident1, Colin Deschanvres, MD1, David Boutoille, MD, PhD1, Marie-Emmanuelle Juvin, PhD2, Karim Lakhal, MD3, Vincent Roualdes, MD4, Benjamin Gaborit, MD1, Paul Leturnier, MD1, Raphael Lecomte, MD1, François Raffi, MD, PhD1, Lydie Khatchatourian, MD5 and Nathalie Asseray, MD, PhD1, (1)Infectious Diseases, CHU - Hotel Dieu, Nantes, France, (2)Microbiology, CHU - Hotel Dieu, Nantes, France, (3)Intensive Care Unit, CHU - Laënnec, Nantes, France, (4)Neurosurgery, CHU - Laënnec, Nantes, France, (5)Infectious Diseases, CH Cornouaille, Quimper, France

    Disclosures:

    A. Khati, None

    C. Deschanvres, None

    D. Boutoille, None

    M. E. Juvin, None

    K. Lakhal, None

    V. Roualdes, None

    B. Gaborit, None

    P. Leturnier, None

    R. Lecomte, None

    F. Raffi, None

    L. Khatchatourian, None

    N. Asseray, None

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