Causes and microbiological spectrum of brain abscesses: modern data

Brain abscesses are relatively rare, yet they are life-threatening infections with high risk of persistent neurological impairment in survivors. Effectiveness of therapy depends on understanding the range of probable pathogens. This enables optimal empirical therapy avoiding broad-spectrum combinations and associated risks of drug-drug interactions. Available Russian literature predominantly contains case reports and reviews resulting in a lack of up-to-date epidemiological data on brain abscesses.

OBJECTIVE

To analyze current etiological and epidemiological data in a cohort of patients with verified brain abscesses.

MATERIAL AND METHODS

A single-center retrospective study enrolled 41 patients with primary brain abscesses between 2022 and 2025. The diagnosis was confirmed by contrast-enhanced MRI and/or intraoperative findings. Exclusion criteria: extracranial abscess, concomitant intracranial or head soft tissue infection and recurrent abscesses.

RESULTS

Abscesses occurred as complications of neurosurgery in 16 (39%) out of 41 patients, ENT diseases — in 4 (9.8%) cases. Odontogenic route of infection was established in 4 (9.8%) cases, and 2 (4.9%) patients had previous traumatic brain injury. Etiology was unknown in 36.6% of cases. Gram-positive cocci prevailed: Staphylococcus spp. (26.8%) and Streptococcus spp. (19.5%).

CONCLUSION

These data highlight the need for regular updating of local epidemiological data on brain abscesses. A thorough analysis of anamnestic data in these patients can enable informed and timely prescription of appropriate empirical antimicrobial therapy. Choice of this therapy depends crucially on spectrum of probable pathogens, especially in the absence of microbiological verification.