Brain abscess caused by oral cavity bacteria: a nationwide, population-based cohort study

Jacob Bodilsen*, Theis Mariager, Lærke Storgaard Duerlund, Merete Storgaard, Lykke Larsen, Christian Thomas Brandt, Birgitte Rønde Hansen, Lothar Wiese, Lars Haukali Omland, Henrik Nielsen, DASGIB study group

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

1 Citationer (Scopus)

Abstract

Background. Oral cavity bacteria are the most frequent etiology of brain abscess. Yet, data on the clinical presentation and outcome are scarce. Methods. We performed a nationwide, population-based study comprising all adults (aged ≥18 years) with brain abscess due to oral cavity bacteria in Denmark from 2007 through 2020. Prognostic factors for unfavorable outcome (Glasgow outcome scale, 1–4) were examined using modified Poisson regression to compute adjusted relative risks (RRs) with 95% confidence intervals (CIs). Results. Among 287 identified patients, the median age was 58 years (interquartile range, 47–66), and 96 of 287 (33%) were female. Preexisting functional impairment was absent or mild in 253 of 280 (90%), and risk factors for brain abscess included immunocompromise in 95 of 287 (33%), dental infection in 68 of 287 (24%), and ear–nose–throat infection in 33 of 287 (12%). Overall, a neurological deficit was present in 246 of 276 (86%) and in combination with headache and fever in 64 of 287 (22%). Identified microorganisms were primarily the Streptococcus anginosus group, Fusobacterium, Actinomyces, and Aggregatibacter spp., and 117 of 287 (41%) were polymicrobial. Unfavorable outcome occurred in 92 of 246 (37%) at 6 months after discharge and was associated with antibiotics before neurosurgery (RR, 3.28; 95% CI, 1.53–7.04), rupture (RR, 1.89; 95% CI, 1.34–2.65), and immunocompromise (RR, 1.80; 95% CI, 1.29–2.51), but not with specific targeted antibiotic regimens. Identified dental infection was associated with favorable prognosis (RR, 0.58; 95% CI, .36–.93). Conclusions. Brain abscess due to oral cavity bacteria often occurred in previously healthy individuals without predisposing dental infections. Important risk factors for unfavorable outcome were rupture and immunocompromise. However, outcome was not associated with specific antibiotic regimens supporting carbapenem-sparing strategies.

OriginalsprogEngelsk
Artikelnummerciad678
TidsskriftClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Vol/bind78
Udgave nummer3
Sider (fra-til)544–553
Antal sider10
ISSN1058-4838
DOI
StatusUdgivet - 20 mar. 2024

Bibliografisk note

© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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