Clinical features and outcome of brain abscess after introduction of CT and MRI: A meta-analysis

Objective

To describe the clinical features and outcome of brain abscess since introduction of computerised tomography and magnetic resonance imaging.

Methods

MEDLINE and Embase were searched using “brain abscess” or “cerebral abscess” from 1970 through 2023 and analyses restricted to study populations hospitalised after 1980. Single-variable meta-analyses were done using a random-effects model.

Results

A total of 21,840 patients from 209 studies were included. The mean age was 34 years (95% confidence interval [CI] 30–38) and 11,817/17,406 (66%, 95% CI 64–67) were male. The aetiologies were consistent across time and continents with Streptococcus spp. 2064/6393 (32%, 95% CI 28–36), Staphylococcus spp. 1061/6393 (14%, 95% CI 12–16), and Gram-negative enteric bacteria 696/6393 (9%, 95% CI 7–11) as the most common. Predisposing conditions included otitis media/mastoiditis 1909/6433 (27%, 95% CI 22–33), immunocompromise 1022/4652 (19%, 95% CI 14–24), sinusitis 565/3725 (16%, 95% CI 12–20), and neurosurgery 745/4927 (16%, 95% CI 12–20). The case-fatality was 2444/18,991 (12%, 95% CI 11–14) and good recovery was found in 3419/5409 (63%, 95% CI 58–68).

Conclusions and relevance

Brain abscess remains a disease predominantly occurring in men and is caused by contiguous or distant infections. Case fatality and outcome have not improved during recent decades.