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Brain abscess in children, a two-centre audit: outcomes and controversies
  1. Vianney Gilard1,2,
  2. Kévin Beccaria1,
  3. John C Hartley3,
  4. Stéphane Blanot4,
  5. Sophie Marqué4,
  6. Marie Bourgeois1,
  7. Stephanie Puget1,
  8. Dominic Thompson1,
  9. Michel Zerah2,
  10. Martin Tisdall2
  1. 1 Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
  2. 2 Department of Pediatric Neurosurgery, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
  3. 3 Microbiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  4. 4 Department of Paediatric Neuro-Critical Care and Anaesthesia, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris, France
  1. Correspondence to Dr Vianney Gilard, Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Paris 5 University, Paris 75015, France; vianneygilard{at}hotmail.fr

Abstract

Objective The aim of this study was to better characterise clinical presentation, management and outcome in infants and children with brain abscess.

Methods The authors conducted a retrospective, multicentre study in two national reference centres over a 25-year period (1992–2017). During this period, 116 children and 28 infants (age <1 year) with brain abscess were treated.

Results The median age at diagnosis was 101.5 (range: 13–213) months in children and 1 (0–11) month in infants. Significant differences were observed between children and infants. The most common predisposing factor was meningitis in infants (64% of cases vs 3% in children), while it was otolaryngology-related infection in children (31% of cases vs 3.6% in infants). Infants presented more frequently with fever and meningism compared with children. 115 patients were treated with aspiration and 11 with excision. Reoperation was required in 29 children vs 1 infant. The overall mortality rate was 4% (3.4% for children, 7.1% for infants). At 3-month follow-up, the outcome was favourable in 86% of children vs in 68% of infants.

Conclusion There is a clear difference between children and infants with brain abscess in terms of predisposing factors, causative organisms and outcome. Despite surgical drainage and directed antibiotic therapy, 25% of patients with brain abscess require reoperation. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population.

  • brain abscess
  • children
  • paediatric neurosurgery
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Footnotes

  • VG and KB contributed equally.

  • Contributors VG collected the data and wrote the manuscript. KB and MT conceptualised and designed the study, and revised the manuscript. SM collected part of the data and revised the manuscript. JCH, SB, MB, SP, DT and MZ contributed to conceptualisation of the study and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The Great Ormond Street Hospital Ethics Committee (registration number: 2210) approved the current study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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