BACKGROUND Brain abscess is an uncommon condition, but carries high mortality. Current treatment guidelines are based on limited data. Surveillance of clinical, radiological and microbiology data is important to inform patient stratification, interventions, and antimicrobial stewardship. METHODS We undertook a retrospective, observational study of patients with brain abscess, based on hospital coding, in a UK tertiary referral teaching hospital. We reviewed imaging data, laboratory microbiology, and antibiotic prescriptions. RESULTS Over a 47 month period, we identified 47 adults with bacterial brain abscess (77% male, median age 47 years). Most of the abscesses were solitary frontal or parietal lesions. A microbiological diagnosis was secured in 39/47 (83%) of cases, among which the majority were of the Streptococcus milleri group (27/39; 69%), with a predominance of Streptococcus intermedius (19/27; 70%). Patients received a median of 6 weeks of intravenous antibiotics (most commonly ceftriaxone), with variable oral follow-on regimens. Ten patients (21%) died, up to 146 days after diagnosis. Mortality was significantly associated with increasing age, multiple abscesses, immunosuppression and the presence of an underlying cardiac anomaly. CONCLUSION Our data suggest that there has been a shift away from staphylococcal brain abscesses, towards S. intermedius as a dominant pathogen. In our setting, empiric current first line therapy with ceftriaxone remains appropriate on microbiological grounds and narrower spectrum therapy may sometimes be justified. Mortality of this condition remains high among patients with comorbidity. Prospective studies are required to inform optimum dose, route and duration of antimicrobial therapy.

中文翻译：

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英国队列中脑脓肿的微生物病因：中间链球菌的突出作用。

背景技术脑脓肿是一种不常见的疾病，但死亡率很高。当前的治疗指南基于有限的数据。临床、放射学和微生物学数据的监测对于告知患者分层、干预和抗菌药物管理非常重要。方法 我们在英国一家三级转诊教学医院根据医院编码对脑脓肿患者进行了一项回顾性观察性研究。我们审查了影像数据、实验室微生物学和抗生素处方。结果 在 47 个月期间，我们确定了 47 名患有细菌性脑脓肿的成年人（77% 为男性，中位年龄 47 岁）。大多数脓肿是孤立的额叶或顶叶病变。39/47 (83%) 的病例得到了微生物学诊断，其中大多数是米氏链球菌组 (27/39; 69%)，以中间链球菌为主（19/27；70%）。患者接受中位数为 6 周的静脉内抗生素（最常见的是头孢曲松），以及不同的口服后续方案。10 名患者（21%）在诊断后长达 146 天死亡。死亡率与年龄增长、多发性脓肿、免疫抑制和潜在心脏异常的存在显着相关。结论 我们的数据表明，葡萄球菌脑脓肿已从中间葡萄球菌转移到作为主要病原体的中间葡萄球菌。在我们的环境中，目前头孢曲松的经验性一线治疗从微生物学的角度来看仍然是合适的，并且有时可以证明更窄谱的治疗是合理的。在合并症患者中，这种情况的死亡率仍然很高。需要进行前瞻性研究以告知最佳剂量，