To examine antimicrobial management of brain abscess and prioritize future trials. Self-administered, Internet-based survey of practices for treatment of community-acquired bacterial brain abscess among infectious diseases (ID) specialists in France, Sweden, Australia, and Denmark during November 2019. Respondents were also asked to rank future randomized controlled trials (RCTs) from 1 (high priority) to 6 (low priority). 310 ID specialists (45% female) from France (35%), Sweden (29%), Australia (25%), and Denmark (11%) participated in the survey, primarily from university hospitals (69%) with an on-site neurosurgical department (61%). Preferred empiric intravenous (IV) antimicrobials were cefotaxime (154/273, 56%) or ceftriaxone (68/273, 25%) combined with metronidazole for a median of 4 weeks (IQR 4–6), 4 weeks (IQR 2–4), and 6 weeks (IQR 4–6) for aspirated, excised, and conservatively treated patients, respectively. Early transition to oral antimicrobials (i.e., < 4 weeks of IV antimicrobials) was used by 134/269 (50%), whereas consolidation therapy with oral antimicrobials after a standard IV regimen (i.e., 4–8 weeks) was used by 123/264 (47%). Median prioritization scores for future RCTs were as follows: 1 (IQR 1–2) for an early transition to oral antimicrobials and duration of therapy, 3 (IQR 2–4) for comparisons of antimicrobial regimens, use of adjunctive dexamethasone, and neurosurgical aspiration versus excision, and 4 (IQR 3–5) for intracavitary antimicrobial instillation and drainage, and for prophylactic anti-epileptic therapy. Willingness to include patients into RCTs reflected prioritization scores. Duration of intravenous antimicrobial treatment and use of oral antimicrobials varies substantially among ID specialists. RCTs are needed to define optimal treatment of brain abscess.

检查脑脓肿的抗菌治疗并确定未来的试验优先次序。在2019年11月期间，法国，瑞典，澳大利亚和丹麦的传染病（ID）专家对基于互联网的自我管理的社区获得性细菌性脑脓肿的治疗方法进行了自我管理调查。还要求受访者对未来的随机对照试验进行排名（ RCT）从1（高优先级）到6（低优先级）。来自法国（35％），瑞典（29％），澳大利亚（25％）和丹麦（11％）的310名ID专家（45％为女性）参加了调查，主要来自大学医院（69％）。部位神经外科（61％）。首选的经验性静脉（IV）抗菌药物为头孢噻肟（154/273，56％）或头孢曲松（68/273，25％）与甲硝唑联用，分别为中位4周（IQR 4–6），4周（IQR 2–4） ），分别为吸入性，切除性和保守治疗的患者6周（IQR 4-6）。134/269（50％）使用早期过渡到口服抗菌药物（即，IV抗菌药物少于4周）（50％），而标准静脉注射方案（即4-8周）后使用口服抗菌药物的巩固治疗为123/269。 264（47％）。未来RCT的中位优先评分如下：1（IQR 1–2）用于早期过渡至口服抗菌药物和治疗持续时间，3（IQR 2–4）用于比较抗菌药物方案，辅助地塞米松的使用和神经外科手术抽吸与切除相比，腔内抗菌素滴注和引流以及预防性抗癫痫治疗为4（IQR 3-5）。将患者纳入RCT的意愿反映了优先级评分。在ID专家之间，静脉抗微生物药物治疗的持续时间和口服抗微生物药物的使用差异很大。需要RCT来定义脑脓肿的最佳治疗方法。