Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): T. Mariager (1), L.S. Duerlund (1), L. Larsen (2), M. Storgaard (3), C.T. Brandt (4), B.R. Hansen (5), J. Helweg-Larsen (6), H.R. Lüttichau (7), L. Wiese (8), H. Nielsen (1), J. Bodilsen (1)
Authors Affiliations(s): (1) Aalborg University Hospital, Denmark, (2) Odense University Hospital, Denmark, (3) Aarhus University Hospital, Denmark, (4) Hillerød Hospital, Denmark, (5) Hvidovre Hospital, Denmark, (6) Rigshospitalet, Denmark, (7) Herlev Hospital, Denmark, (8) Roskilde Hospital, Denmark
Third Party Affiliation: DASGIB study group
Background:
Oral cavity bacteria are the most common cause of brain abscess. However, data on this specific type of brain abscess are limited.
Methods:Nationwide, population-based cohort study combining medical record review of all adults diagnosed with brain abscess in the Danish National Patient Registry (2007 through 2015) and the prospective Danish Study Group of the Brain (DASGIB) clinical database of patients treated for central nervous system infection at departments of infectious diseases in Denmark (2015 through 2020). Only patients with documented brain abscess caused by oral cavity bacteria were included. Outcome was assessed according to the Glasgow Outcome Scale (GOS) with scores of 1-4 categorized as unfavourable outcome. Modified Poisson regression was used to compute adj. RRs with 95% CIs for unfavourable outcome at discharge adjusted for age>65 years, sex, Glasgow Coma Scale (GCS) <12 at admission, largest diameter of brain abscess (+/- 3 cm), adjunctive corticosteroids, multiple brain abscesses, and immuno-compromise.
Results:Oral cavity bacteria were the causative pathogen in 280 brain abscess patients with a median age of 57 years (IQR 46-66) and 35% were females. Major predisposing conditions were immuno-compromise (32%), dental infection (23%), and ear-nose-throat (ENT) infection (13%). Symptoms and findings at admission included headache (71%), history of fever (50%), and cognitive impairment (45%). The median c-reactive protein was 22 mg/L (IQR 7-71). Brain abscesses were most frequently found in the frontal lobes (41%) followed by the parietal lobes (33%), and the temporal lobes (24%). The median diameter of the brain abscess was 3.0 cm (IQR 2.0-4.0). Antibiotic treatment consisted mainly of cephalosporin-based regimens (63%). Admission to the intensive care unit was frequent (32%) and common complications during admission were seizures (23%), rupture of brain abscess (16%), and hydrocephalus (10%). In-hospital mortality was 6/269 (2%) and unfavourable outcome observed in 189/269 (70%) at discharge. Rupture of brain abscess was an independent risk factor for unfavourable outcome at discharge (adj. RR 1.21 [95% CI 1.01-1.46]).
Conclusions:Brain abscess caused by oral cavity bacteria is associated with a dental or ENT focus and rupture of brain abscess is common. Although mortality is low, unfavourable outcome is frequent.
Keyword(s): Brain abscess, Oral Cavity Bacteria, EpidemiologySession Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): T. Mariager (1), L.S. Duerlund (1), L. Larsen (2), M. Storgaard (3), C.T. Brandt (4), B.R. Hansen (5), J. Helweg-Larsen (6), H.R. Lüttichau (7), L. Wiese (8), H. Nielsen (1), J. Bodilsen (1)
Authors Affiliations(s): (1) Aalborg University Hospital, Denmark, (2) Odense University Hospital, Denmark, (3) Aarhus University Hospital, Denmark, (4) Hillerød Hospital, Denmark, (5) Hvidovre Hospital, Denmark, (6) Rigshospitalet, Denmark, (7) Herlev Hospital, Denmark, (8) Roskilde Hospital, Denmark
Third Party Affiliation: DASGIB study group
Background:
Oral cavity bacteria are the most common cause of brain abscess. However, data on this specific type of brain abscess are limited.
Methods:Nationwide, population-based cohort study combining medical record review of all adults diagnosed with brain abscess in the Danish National Patient Registry (2007 through 2015) and the prospective Danish Study Group of the Brain (DASGIB) clinical database of patients treated for central nervous system infection at departments of infectious diseases in Denmark (2015 through 2020). Only patients with documented brain abscess caused by oral cavity bacteria were included. Outcome was assessed according to the Glasgow Outcome Scale (GOS) with scores of 1-4 categorized as unfavourable outcome. Modified Poisson regression was used to compute adj. RRs with 95% CIs for unfavourable outcome at discharge adjusted for age>65 years, sex, Glasgow Coma Scale (GCS) <12 at admission, largest diameter of brain abscess (+/- 3 cm), adjunctive corticosteroids, multiple brain abscesses, and immuno-compromise.
Results:Oral cavity bacteria were the causative pathogen in 280 brain abscess patients with a median age of 57 years (IQR 46-66) and 35% were females. Major predisposing conditions were immuno-compromise (32%), dental infection (23%), and ear-nose-throat (ENT) infection (13%). Symptoms and findings at admission included headache (71%), history of fever (50%), and cognitive impairment (45%). The median c-reactive protein was 22 mg/L (IQR 7-71). Brain abscesses were most frequently found in the frontal lobes (41%) followed by the parietal lobes (33%), and the temporal lobes (24%). The median diameter of the brain abscess was 3.0 cm (IQR 2.0-4.0). Antibiotic treatment consisted mainly of cephalosporin-based regimens (63%). Admission to the intensive care unit was frequent (32%) and common complications during admission were seizures (23%), rupture of brain abscess (16%), and hydrocephalus (10%). In-hospital mortality was 6/269 (2%) and unfavourable outcome observed in 189/269 (70%) at discharge. Rupture of brain abscess was an independent risk factor for unfavourable outcome at discharge (adj. RR 1.21 [95% CI 1.01-1.46]).
Conclusions:Brain abscess caused by oral cavity bacteria is associated with a dental or ENT focus and rupture of brain abscess is common. Although mortality is low, unfavourable outcome is frequent.
Keyword(s): Brain abscess, Oral Cavity Bacteria, Epidemiology
Session Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): T. Mariager (1), L.S. Duerlund (1), L. Larsen (2), M. Storgaard (3), C.T. Brandt (4), B.R. Hansen (5), J. Helweg-Larsen (6), H.R. Lüttichau (7), L. Wiese (8), H. Nielsen (1), J. Bodilsen (1)
Authors Affiliations(s): (1) Aalborg University Hospital, Denmark, (2) Odense University Hospital, Denmark, (3) Aarhus University Hospital, Denmark, (4) Hillerød Hospital, Denmark, (5) Hvidovre Hospital, Denmark, (6) Rigshospitalet, Denmark, (7) Herlev Hospital, Denmark, (8) Roskilde Hospital, Denmark
Third Party Affiliation: DASGIB study group
Background:
Oral cavity bacteria are the most common cause of brain abscess. However, data on this specific type of brain abscess are limited.
Methods:Nationwide, population-based cohort study combining medical record review of all adults diagnosed with brain abscess in the Danish National Patient Registry (2007 through 2015) and the prospective Danish Study Group of the Brain (DASGIB) clinical database of patients treated for central nervous system infection at departments of infectious diseases in Denmark (2015 through 2020). Only patients with documented brain abscess caused by oral cavity bacteria were included. Outcome was assessed according to the Glasgow Outcome Scale (GOS) with scores of 1-4 categorized as unfavourable outcome. Modified Poisson regression was used to compute adj. RRs with 95% CIs for unfavourable outcome at discharge adjusted for age>65 years, sex, Glasgow Coma Scale (GCS) <12 at admission, largest diameter of brain abscess (+/- 3 cm), adjunctive corticosteroids, multiple brain abscesses, and immuno-compromise.
Results:Oral cavity bacteria were the causative pathogen in 280 brain abscess patients with a median age of 57 years (IQR 46-66) and 35% were females. Major predisposing conditions were immuno-compromise (32%), dental infection (23%), and ear-nose-throat (ENT) infection (13%). Symptoms and findings at admission included headache (71%), history of fever (50%), and cognitive impairment (45%). The median c-reactive protein was 22 mg/L (IQR 7-71). Brain abscesses were most frequently found in the frontal lobes (41%) followed by the parietal lobes (33%), and the temporal lobes (24%). The median diameter of the brain abscess was 3.0 cm (IQR 2.0-4.0). Antibiotic treatment consisted mainly of cephalosporin-based regimens (63%). Admission to the intensive care unit was frequent (32%) and common complications during admission were seizures (23%), rupture of brain abscess (16%), and hydrocephalus (10%). In-hospital mortality was 6/269 (2%) and unfavourable outcome observed in 189/269 (70%) at discharge. Rupture of brain abscess was an independent risk factor for unfavourable outcome at discharge (adj. RR 1.21 [95% CI 1.01-1.46]).
Conclusions:Brain abscess caused by oral cavity bacteria is associated with a dental or ENT focus and rupture of brain abscess is common. Although mortality is low, unfavourable outcome is frequent.
Keyword(s): Brain abscess, Oral Cavity Bacteria, EpidemiologySession Type: 1,5-hour Oral Session
Session Title: 1,5-hour Oral Session
Authors(s): T. Mariager (1), L.S. Duerlund (1), L. Larsen (2), M. Storgaard (3), C.T. Brandt (4), B.R. Hansen (5), J. Helweg-Larsen (6), H.R. Lüttichau (7), L. Wiese (8), H. Nielsen (1), J. Bodilsen (1)
Authors Affiliations(s): (1) Aalborg University Hospital, Denmark, (2) Odense University Hospital, Denmark, (3) Aarhus University Hospital, Denmark, (4) Hillerød Hospital, Denmark, (5) Hvidovre Hospital, Denmark, (6) Rigshospitalet, Denmark, (7) Herlev Hospital, Denmark, (8) Roskilde Hospital, Denmark
Third Party Affiliation: DASGIB study group
Background:
Oral cavity bacteria are the most common cause of brain abscess. However, data on this specific type of brain abscess are limited.
Methods:Nationwide, population-based cohort study combining medical record review of all adults diagnosed with brain abscess in the Danish National Patient Registry (2007 through 2015) and the prospective Danish Study Group of the Brain (DASGIB) clinical database of patients treated for central nervous system infection at departments of infectious diseases in Denmark (2015 through 2020). Only patients with documented brain abscess caused by oral cavity bacteria were included. Outcome was assessed according to the Glasgow Outcome Scale (GOS) with scores of 1-4 categorized as unfavourable outcome. Modified Poisson regression was used to compute adj. RRs with 95% CIs for unfavourable outcome at discharge adjusted for age>65 years, sex, Glasgow Coma Scale (GCS) <12 at admission, largest diameter of brain abscess (+/- 3 cm), adjunctive corticosteroids, multiple brain abscesses, and immuno-compromise.
Results:Oral cavity bacteria were the causative pathogen in 280 brain abscess patients with a median age of 57 years (IQR 46-66) and 35% were females. Major predisposing conditions were immuno-compromise (32%), dental infection (23%), and ear-nose-throat (ENT) infection (13%). Symptoms and findings at admission included headache (71%), history of fever (50%), and cognitive impairment (45%). The median c-reactive protein was 22 mg/L (IQR 7-71). Brain abscesses were most frequently found in the frontal lobes (41%) followed by the parietal lobes (33%), and the temporal lobes (24%). The median diameter of the brain abscess was 3.0 cm (IQR 2.0-4.0). Antibiotic treatment consisted mainly of cephalosporin-based regimens (63%). Admission to the intensive care unit was frequent (32%) and common complications during admission were seizures (23%), rupture of brain abscess (16%), and hydrocephalus (10%). In-hospital mortality was 6/269 (2%) and unfavourable outcome observed in 189/269 (70%) at discharge. Rupture of brain abscess was an independent risk factor for unfavourable outcome at discharge (adj. RR 1.21 [95% CI 1.01-1.46]).
Conclusions:Brain abscess caused by oral cavity bacteria is associated with a dental or ENT focus and rupture of brain abscess is common. Although mortality is low, unfavourable outcome is frequent.
Keyword(s): Brain abscess, Oral Cavity Bacteria, Epidemiology