The Importance Of Antibiotic Stewardship In The Management Of Brain Abscesses

Internal Medicine Unit, Ospedale del Mare, ASL Napoli 1 Centro, Internal Medicine Unit, Ospedale del Mare, ASL Napoli 1 Centro
Postgraduate Specialization School of Internal Medicine, University of Naples Federico II, Naples, Italy
Neurosurgery Unit Ospedale del Mare, ASL Napoli 1 Centro, Naples, Italy
Neuroradiology Unit Ospedale del Mare, ASL Napoli 1Centro, Naples, Italy

Scientific Tracks Abstracts: Health Sci J

Abstract:

Background The incidence of brain abscess appears to be increasing in recent decades. The risk factors are dental infections, chronic ear-nose-throat infections, immunocompromise and previous neurosurgery. Mortality until a few years ago was about 40% and although it has improved in recent years, the 30-day and 1-year mortalities remain high at 7% and 20%, respectively. Treatment of abscesses involves neurosurgical aspiration surgical drainage of the abscess usually followed by a prolonged course of antibiotics- 6-8 weeks of intravenous antimicrobials-. Case Report A 48-year-old woman presented to the emer-gency department for headache after treatment for odonto-genic abscess. The brain CT showed an hypodense area in the left paratrigonal parieto-occipital region with edema, compatible with an abscess. He has been subjected to ab-scess drainage with culturing. We introduced empirical an-tibiotic therapy with Ceftriaxone, Metronidazole, Linezolid. A control brain CT showed persistence of small abscess.Due to persistence of fever Ceftriaxone was replaced with Meropenem.The drainage culture was positivity for Sphin-gomonas paucimobilis. After 10 days, when clinical and strumental pictures showed a total resolution, the patient was discharged with Metronidazole and trimetoprim/sulfametoxazolo for 4 weeks. Case Report 2 A 62-year-old patient was admitted to our In-ternal Medicine Unit after a long hospitalization in Intensive care for surgical treatment of a fronto-parietal brain abscess, complicated by M.O.F. The brain CT showed a persistence of a small abscess. At the maxillofacial specialist visit, he presented apical granuloma of the 26th tooth. BAS was found to be positive for Klebsiella KPC, Pseudomonas Aeruginosa, Candida albicans; blood culture positive for Providencia stuartii. Patient was treated with cefiderocol for 14 days and subsequently he started trimetoprim/ sulfame-toxazolo for 4 weeks. Clinical and strumental pictures showed a total resolution. Discussion Treatment of abscesses involves neurosurgical aspiration surgical drainage of the abscess usually followed by a prolonged course of antibiotics- 6-8 weeks of intravenous antimicrobials-. Some experts to suggest early transition to oral antimicrobials after 1-2 weeks depending on clinical response especiall in patients with mild and uncomplicated brain abscess This strategy is useful to reduce risks associated with prolonged hospitalization and intravenous lines. Timely and targeted antibiotic ther-apy is essential to reduce morbidity and mortality.

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