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Purpose <p>We sought to describe current perceptions and attitudes to management of of brain abscess (BA) or sub-/extra-dural empyema (SDE/EDE) in the United Kingdom (UK) to compare this to the 2024 European Society of Clinical Microbiology and Infectious Diseases BA guidelines.</p> Methods <p>We conducted a web-based survey of infection specialists (IS) and neurosurgeons (NS) at neurosurgical centres across the UK.</p> Results <p>IS from 27/39 (69%) and NS from 18/39 (46%) UK neurosurgical centres participated. All IS reported use of a third-generation cephalosporin as empirical antibiotic therapy, 57/61 (93%) alongside metronidazole, 19/57 (33%) preferring oral metronidazole throughout treatment. Most IS (46/60, 76.7%) consider switching to oral antibiotics prior to completing 6 weeks intravenous (IV) therapy, with 33/46 (71.7%) considering a 1–2 week minimum IV duration if there has been neurosurgical intervention. Most NS (22/25, 88%) agreed that neurosurgical intervention is indicated for any BA <i>≥</i> 2.5&#xa0;cm diameter, most (21/25, 84%) favouring burr hole aspiration. For SDE/EDE only 12/25 (48%) of NS would surgically intervene in all circumstances. Most IS and NS (72/76, 94.7%) would consider intrathecal antibiotics in ruptured BA with ventriculitis; only 11/74 (14%) reported experience with intracavitary antimicrobials. 44/74 (59%) reported using steroids in BA, while 20/74 (27%) reported avoiding steroids. Reimaging was favoured at 2–3 weeks by NS, IS favoured 4–8 weeks, or not reimaging.</p> Conclusion <p>There are areas of marked variation in the management of BA and SDE/EDE in the UK, particularly early switch from IV to oral antibiotics, SDE surgery, repeat brain imaging and use of steroids.</p>

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Management of community-acquired brain abscess and intracranial empyema: a survey of UK neurosurgical centres

  • 期刊论文

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  • 发表日期：

    2026年5月4日

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  • Carmen Thompson Perea,
  • Holly Roy,
  • James Hatcher,
  • Sophia de Saram,
  • Jacob Bodilsen,
  • Peter Whitfield,
  • William Singleton,
  • Jack Wildman,
  • Michelle M. Kameda-Smith,
  • Eliza Gil

摘要

Purpose

We sought to describe current perceptions and attitudes to management of of brain abscess (BA) or sub-/extra-dural empyema (SDE/EDE) in the United Kingdom (UK) to compare this to the 2024 European Society of Clinical Microbiology and Infectious Diseases BA guidelines.

Methods

We conducted a web-based survey of infection specialists (IS) and neurosurgeons (NS) at neurosurgical centres across the UK.

Results

IS from 27/39 (69%) and NS from 18/39 (46%) UK neurosurgical centres participated. All IS reported use of a third-generation cephalosporin as empirical antibiotic therapy, 57/61 (93%) alongside metronidazole, 19/57 (33%) preferring oral metronidazole throughout treatment. Most IS (46/60, 76.7%) consider switching to oral antibiotics prior to completing 6 weeks intravenous (IV) therapy, with 33/46 (71.7%) considering a 1–2 week minimum IV duration if there has been neurosurgical intervention. Most NS (22/25, 88%) agreed that neurosurgical intervention is indicated for any BA ≥ 2.5 cm diameter, most (21/25, 84%) favouring burr hole aspiration. For SDE/EDE only 12/25 (48%) of NS would surgically intervene in all circumstances. Most IS and NS (72/76, 94.7%) would consider intrathecal antibiotics in ruptured BA with ventriculitis; only 11/74 (14%) reported experience with intracavitary antimicrobials. 44/74 (59%) reported using steroids in BA, while 20/74 (27%) reported avoiding steroids. Reimaging was favoured at 2–3 weeks by NS, IS favoured 4–8 weeks, or not reimaging.

Conclusion

There are areas of marked variation in the management of BA and SDE/EDE in the UK, particularly early switch from IV to oral antibiotics, SDE surgery, repeat brain imaging and use of steroids.