A recent study conducted at the Bouaké Teaching Hospital in Côte d'Ivoire has shed light on the microbiological yield and factors associated with culture positivity in intracranial suppurative infections (ISI). The study, which analyzed 150 episodes of ISI from 2016 to 2026, found that pus was sampled in 77.3% of episodes, with cultures being positive in 43.1% of sampled patients. The study aimed to quantify the microbiological yield, identify factors associated with culture positivity, and assess the adequacy of empirical antibiotic therapy.
The study revealed that Gram-positive cocci were the predominant organisms isolated, accounting for 82% of the positive cultures. Specifically, streptococci and Staphylococcus aureus were the most common pathogens, making up 42% and 34% of the positive cultures, respectively. The study also found that no prespecified factor was associated with culture positivity, except for continuous age, which was associated with a higher likelihood of positive culture with an adjusted odds ratio of 1.23 per decade.
The study evaluated the adequacy of empirical antibiotic therapy against isolated organisms and found that initial therapy included at least one in-vitro-active agent in 77.3% of episodes with an antibiogram. However, the study noted that the main gap in antibiotic coverage concerned Staphylococcus aureus, with only 53% of cases covered. The study also found that two-thirds of the cohort were treated without an exploitable isolate, and 93% of regimens contained a WHO "Watch" antibiotic.
The study's findings have implications for the management of intracranial suppurative infections in resource-limited settings. The low microbiological yield and lack of association between prespecified factors and culture positivity suggest that deep sampling should be performed whenever feasible, rather than relying on clinical selection. The study also highlights the need for strengthening microbiological capacity and structured stewardship programs to improve antibiotic use.
The study's results are consistent with previous research on brain abscesses and intracranial suppurative infections. A 2014 study published in the New England Journal of Medicine found that brain abscesses are a significant cause of morbidity and mortality worldwide. Another study published in 2020 in the journal Clinical Microbiology and Infection found that the incidence and mortality of brain abscesses in Denmark were higher than previously reported.
The study's authors emphasize the importance of improving microbiological capacity and antibiotic stewardship in resource-limited settings. They suggest that this can be achieved through the implementation of structured stewardship programs and the strengthening of laboratory capacity. The study's findings also highlight the need for further research on the epidemiology and management of intracranial suppurative infections in sub-Saharan Africa.
The study was published in the journal Health Sciences and Diseases and is available online. The study's authors note that the findings have significant implications for clinical practice and public health policy. They hope that the study will contribute to the development of evidence-based guidelines for the management of intracranial suppurative infections in resource-limited settings.
Key points
- The study found that the microbiological yield in intracranial suppurative infections was low, with cultures being positive in only 43.1% of sampled patients.
- The study found that Staphylococcus aureus was a common pathogen isolated, but antibiotic coverage was inadequate, with only 53% of cases covered.
- The study's findings highlight the need for strengthening microbiological capacity and structured stewardship programs to improve antibiotic use in resource-limited settings.
