علاج خراج الدماغ في متلقي زراعة الأعضاء والعلاج الكيميائي النشط والأورام الخبيثة الدموية

DOI: 10.1016/j.cmi.2023.08.016

We strongly recommend neurosurgical aspiration or excision of brain abscess as soon as possible in all patients whenever feasible (excl. toxoplasmosis) (strong recommendation, moderate certainty of evidence).

We conditionally recommend a 3rd-generation cephalosporin and metronidazole combined with trimethoprim-sulfamethoxazole and voriconazole for empirical treatment of brain abscess in children and adults with severe immuno-compromise equivalent to organ transplant recipients, active chemotherapy or biological treatment, or haematological malignancies (Table 4) (conditional recommendation and very low certainty of evidence).

Another study used absence of fever for 10–14 days combined with resolution of abscess on brain imaging to guide treatment in 55 neurosurgically treated patients.

Although the radiological evolution of brain abscess varies considerably, abscess volume is often stationary or only slightly diminished on brain imaging by 2 weeks after aspiration, whereas lack of regression by 4 weeks is unusual.