Thirty years of paediatric brain abscess management: a single-centre retrospective analysis of evolving therapeutic strategies and outcomes.

UNLABELLED: Intracerebral abscesses, although rare in children, represent the most frequent intracranial suppurative infection in children They typically present insidiously and can cause serious complications. Advances such as imaging-guided aspiration and prolonged antibiotics with good central nervous system penetration have improved clinical management. This study presents our single-centre experience over more than three decades, evaluating the impact of evolving therapeutic strategies on outcomes in children. We retrospectively analysed all patients admitted to our centre with confirmed brain abscesses between January 1988 and April 2020. Clinical details, surgical techniques, antibiotic management, and outcomes were collected from clinical charts. Patients were divided into two periods: A (1988-2005) and B (2006-2020). Statistical analysis compared clinical characteristics and outcomes between the two periods. Thirty-two children were included (mean age 5.4 ± 4.4 years): 18 in Period A and 14 in Period B, with positive cultures in 19. Twelve fully recovered, while 20 experienced clinical, radiological, or electroencephalographic sequelae. Younger patients had more severe disease: with larger abscesses under 4.9 years (p = 0.009); and multiple abscesses under 2 years (p < 0.001). Patients with sequelae were younger (p = 0.012), had Intraventricular Rupture of Brain Abscess, IVROBA, (p = 0.002), and multiple abscesses (p = 0.018). Comparing periods, baseline characteristics and corticosteroid administration were similar. IVROBA occurred only in Period A (7/18; p = 0.010). From 2006, management transitioned entirely to stereotactic aspiration with prolonged antibiotics, reducing clinical (p = 0.019) and radiological sequelae (p = 0.005). Mortality was 6.5% overall, occurring only in Period A.

CONCLUSION: Younger children are at higher risk of severe intracerebral abscesses and poorer prognosis. Introduction of standardised protocols including minimally invasive neurosurgery and prolonged antibiotic therapy has led to marked improvements, contributed to a significant reduction in both clinical and radiological sequelae, and effectively eliminated mortality in recent years.

WHAT IS KNOWN: • Intracerebral abscesses in paediatric population are rare. • Younger age is associated with more severe disease.

WHAT IS NEW: • Based on over three decades of single-center experience, the adoption of standardized protocols integrating microbiological evaluation, less invasive neurosurgical techniques, and optimized antibiotic regimens has significantly improved outcomes, virtually eliminating mortality.