Gram Negative Bacillary Brain Abscess: Clinical Features And Therapeutic Outcome

Abstract

Background: :This study was conducted to analyze the clinical features and therapeutic outcome for brain abscesses caused by gram negative bacilli. Methods: 41 patients with gram negative bacillary brain abscess, out of a total of 278 cases, 25 males and 16 female aged 2-72 years were reviewed at IMS, BHU and JN Medical College Hospital AMU, over a 17 year period for Predisposing factors, clinical feature and therapeutic outcome. Results: The most common presenting symptoms were headache, vomiting, fever and altered sensorium. At the time of admission 26.10% had GCS <9. Temporal and temporoparietal was the commonest site and 14.6% had multiple abscesses. The common predisposing factors were otic infection, penetrating trauma and chest infections with diabetes mellitus being the main underlying disease. CT and MRI facilitated early diagnosis. Surgical intervention was done in 97.1% cases. The most common pathogen isolated was pseudomonas in otogenic group, E. coli in head injury group and Klebsiella in hematogenous spread. 39.04% cases were multidrug resistant with pseudomonas being the main culprit. The overall mortality was 26.8% with the presence of septic shock and multidrug resistance being the poor prognostic factors. Conclusion: Brain abscesses caused by gram negative bacilli are not rare and often have a high prevalence of septic shock, multidrug resistance and death. Clinical presentation and therapeutic outcomes vary according to different pathogenic species. In light of high mortality rate an early diagnosis and prompt management is essential to maximize the chance for survival.