Continuous Irrigation for Refractory Multidrug-Resistant Brain Abscess in two Patients.

Introduction: Brain abscesses remain a significant clinical challenge, particularly in cases involving multidrug-resistant (MDR) organisms or failure of standard surgical and medical therapy. Newer adjunctive techniques, such as continuous irrigation therapy, have been explored to enhance infection control and patient outcomes in these complex scenarios.

Case description: We present two cases of brain abscess treated at a tertiary care centre using continuous abscess cavity irrigation after conventional interventions proved insufficient. The first patient, a 15-year-old male, experienced recurrent MDR brain abscesses despite multiple surgical procedures and broad-spectrum antibiotics. Initiation of continuous irrigation, combined with targeted antimicrobial therapy, resulted in rapid clinical stabilisation and marked radiological improvement, with minimal long-term sequelae. The second patient, a 65-year-old female, developed multiple brain abscesses after traumatic brain injury and decompressive surgery. Although continuous irrigation effectively controlled the intracranial infection and imaging confirmed resolution, her neurological recovery was limited due to profound pre-existing brain damage.

Conclusion: Continuous irrigation therapy appears to be a valuable adjunct in the management of refractory or MDR brain abscesses, facilitating rapid infection control when conventional treatments are inadequate. However, ultimate neurological outcomes are largely dependent on the extent of underlying brain injury. These cases highlight the importance of considering continuous irrigation in selected patients and underscore the need for further research and multidisciplinary collaboration to optimise management protocols and improve patient outcomes.

Learning points: Continuous irrigation with alternating saline and antibiotic solutions is an effective adjunct in the management of refractory or multidrug-resistant brain abscesses.Unfortunately, successful infection control does not always guarantee neurological recovery.