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Treatment of community-acquired bacterial brain abscess: a survey among infectious diseases specialists in France, Sweden, Australia, and Denmark

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark

    Jacob Bodilsen & Henrik Nielsen

  2. European Society of Clinical Microbiology and Infectious Diseases Study Group for Infectious Diseases of the Brain, Basel, Switzerland

    Jacob Bodilsen, Pierre Tattevin & Henrik Nielsen

  3. Department of Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France

    Pierre Tattevin

  4. Réseau National de Recherche Clinique en Infectiologie (RENARCI), Paris, France

    Pierre Tattevin

  5. Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

    Steven Tong

  6. Menzies School of Health Research, Charles Darwin University, Darwin, Australia

    Steven Tong

  7. Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden

    Pontus Naucler

  8. Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark

    Henrik Nielsen

Authors
  1. Jacob Bodilsen
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  2. Pierre Tattevin
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  3. Steven Tong
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  4. Pontus Naucler
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  5. Henrik Nielsen
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Contributions

All authors contributed in design, analysis, and interpretation of data. JB wrote the first draft of the report.

Corresponding author

Correspondence to Jacob Bodilsen.

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Approval from an ethical committee was not required for this type of study in the participating countries.

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The authors declare that they have no conflict of interest.

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This study is a collaborative study within the European Study Group for Infectious diseases of the Brain (ESGIB).

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Bodilsen, J., Tattevin, P., Tong, S. et al. Treatment of community-acquired bacterial brain abscess: a survey among infectious diseases specialists in France, Sweden, Australia, and Denmark. Eur J Clin Microbiol Infect Dis 40, 255–260 (2021). https://doi.org/10.1007/s10096-020-04032-1

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  • DOI: https://doi.org/10.1007/s10096-020-04032-1

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