Pediatric focal intracranial suppuration: a UK single-center experience

Cole, Theresa S., Clark, Marcia E., Jenkins, Alistair J. and Clark, Julia E. (2012) Pediatric focal intracranial suppuration: a UK single-center experience. Child's Nervous System, 28 12: 2109-2114. doi:10.1007/s00381-012-1877-7


Author Cole, Theresa S.
Clark, Marcia E.
Jenkins, Alistair J.
Clark, Julia E.
Title Pediatric focal intracranial suppuration: a UK single-center experience
Journal name Child's Nervous System   Check publisher's open access policy
ISSN 0256-7040
1433-0350
Publication date 2012-12
Year available 2012
Sub-type Article (original research)
DOI 10.1007/s00381-012-1877-7
Open Access Status Not yet assessed
Volume 28
Issue 12
Start page 2109
End page 2114
Total pages 6
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Formatted abstract
Purpose: Brain abscess (BA) and subdural empyema (SDE) are uncommon but clinically important conditions in childhood. Treatment involves surgery and prolonged courses of antibiotics. There is no consensus on the optimal approach. The objective was to review management and outcome of BA and SDE in a single UK center.

Methods: This retrospective case notes review of children with brain abscess or subdural empyema admitted to a tertiary pediatric infectious diseases and neurosurgical center from 2001 to 2009.

Results: Forty-two children were included in the study; 17 children were with BA, 23 with SDE, and two both with BA and SDE. The causative factors found in 88 % of the patients were most commonly sinusitis and meningitis with congenital heart disease and immunocompromise unusual. Streptococcus anginosus group organisms were most common; 10 % of the children had a resistant pathogen and 86 % had surgical intervention. Fifteen patients with BA underwent surgery; nine of these patients underwent burrhole aspiration, three had craniotomy, two had stereotactic surgery, and one had endoscopic aspiration. Remaining 19 patients with SDE underwent surgery: seven had burrhole aspiration, 11 underwent craniotomy, and one had aspiration via the anterior fontanel. The most common antibiotic regime was cefotaxime, metronidazole, and amoxicillin. Mean duration of treatment was 14.4 weeks. Mean time until normalization of C reactive protein was 23 days. Survival was 95 % and 20 % had ongoing neurological sequelae.

Conclusions: BA and SDE remain important childhood infections in the UK. Antibiotics are essential in the management of these cases. Empiric antibiotic choices require knowledge of likely pathogens and local resistance. Selected infections can be treated without surgical intervention. Long courses of antibiotics were administered. Outcome is good, and neurological sequelae were less common than found in previous series.
Keyword Brain abscess
Infection
Subdural empyema
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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