Safe early switch to oral antibiotics in immunocompetent adults with intracranial bacterial suppurations: Retrospective of a 25-year experience in a tertiary care centre

Abstract

Background

Switching antibiotic therapy from intravenous to oral route (IVOS) has become the standard of care for many deep-seated infections. IVOS seems applicable to intracranial bacterial suppurations (ICBS) with a good safety profile but remains debated and has shown insufficient evidence to be recommended in the latest guidelines. We hypothesize that early IVOS is not associated with a poorer neurological prognosis.

Material

We conducted a single-center retrospective cohort study in a French tertiary hospital between October 1998 and June 2022. We included adult patients neuro-surgically treated for ICBS, who survived early hospitalization. The primary endpoint was to determine if outcome was associated with the duration of intravenous antibiotic therapy prior to IVOS. Secondary endpoints were total duration of antibiotic treatment, adverse effects and safety parameters.

Results

We analysed data for 190 patients of whom 91 % underwent IVOS, after a median 9 days (IQR 5–15) of intravenous route. Patients with a favourable 6-month outcome (Glasgow Outcome Scale Extended ≥ 7) were more likely to receive shorter intravenous treatment (8 (IQR 5–15) versus 13 (IQR 5–23) days, p = 0.035). Patients having undergone early IVOS had fewer surgical revisions (p = 0.002). Treatment side effects did not differ between groups.

Conclusion

In patients with intracranial bacterial suppurations who have undergone surgery and are adequately monitored, switching from intravenous to oral antibiotics was not associated with a worse outcome, even when performed early. The absence of association between IVOS and death or poorer outcome requires confirmation in further studies.