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Volume 42, Number 5, October 2009

Microbiology and epidemiology of brain abscess and subdural empyema ina medicial center: A 10-year experience.


Tsung-Pei Tsou, Ping-Ing Lee, Chun-Yi Lu, Luan-Yin Chang, Lin-Min Huang, Jong-Min Chen, Po-Ren Hsueh, Chin-Yun Lee


Received: May 1, 2008    Revised: June 2, 2008    Accepted: June 25, 2008   

 

Corresponding author:

Dr. Ping-Ing Lee, Department of Pediatrics, Noational TaiwanUniversity Hsopital, No. 7, Chun Shang South Rd., Taipei 10002, Taiwan. Email: pinging@ntu.edu.tw



 

Background and purpose: 

Brain abcess and subdural empyema are the 2 most common forms of intractranial pyogenic infecdtions. Predisposing factors and etiological agents may changewith time. This study examined the epidemiological features of these conditions.



 

Methods:

The medical records of all inpatients with a diagnosis of brain abscess or subdural empyema from 1008 to 2007 were reviewed. The diagnosis was confirmed by imaging study or operative findings.



 

Results:

151 episodes of brain abscess were diagnosed in150 paitents, and 10 patients had subdural empyema. The incidence of brain abscess fluctuated over time, while that of subdural empyema remained stable. The mean+- stardard deviation age of patients with bran abscess was significantly greater than that of patients withsubdural empyema (48.5+-19 years vs 25.4+- years; p-0.004). The number of patients with hematogenous brain abscess increased from 7 in 1998 to 2002 to 19 in 2003 to 2007. while that of those with infection related to operation decreased from 10 to 5. Most subdural empyema was related to bacterial meningitis (4 of 10). Etiological agents were identifed in 53.% of brain abscesses, including enterobacteriaceae spp. (21.3%), Streptococcus spp. (20%), and mixed pathogens (17.5%). Klebsiella pneumoniae was the most common enteric bacteria isolated (15.3%), especially in patients withdiabetes mellitus, but was not observed in children younger than 18 years.



 

Conclusion:

In contrast to western countries, K. pneumoniae plays an importantrole inintracranial pyogenic infections in Taiwan. The pathogens and routes of infection are different between children and adults.



 

Key words:

Brain absecess; Empyema, subdural