Department of Pediatrics, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan.
J Microbiol Immunol Infect. 2009 Oct;42(5):405-12.
Brain abscess and subdural empyema are the 2 most common forms of intracranial pyogenic infections. Predisposing factors and etiological agents may change with time. This study examined the epidemiological features of these conditions.
The medical records of all inpatients with a diagnosis of brain abscess or subdural empyema from 1998 to 2007 were reviewed. The diagnosis was confirmed by imaging study or operative findings.
151 episodes of brain abscess were diagnosed in 150 patients, and 10 patients had subdural empyema. The incidence of brain abscess fluctuated over time, while that of subdural empyema remained stable. The mean +/- standard deviation age of patients with brain abscess was significantly greater than that of patients with subdural empyema (48.5 +/- 19 years vs 25.4 +/- 24 years; p = 0.004). The number of patients with hematogenous brain abscess increased from 7 in 1998 to 2002 to 19 in 2003 to 2007, while that of those with infection related to operation decreased from 10 to 5. Most subdural empyema was related to bacterial meningitis (4 of 10). Etiological agents were identified in 53% of brain abscesses, including Enterobacteriaceae spp. (21.3%), Streptococcus spp. (20%), and mixed pathogens (17.5%). Klebsiella pneumoniae was the most common enteric bacteria isolated (15.3%), especially in patients with diabetes mellitus, but was not observed in children younger than 18 years.
In contrast to western countries, K. pneumoniae plays an important role in intracranial pyogenic infections in Taiwan. The pathogens and routes of infection are different between children and adults.
脑脓肿和硬脑膜下积脓是颅内化脓性感染的两种最常见形式。致病因素和病原体可能随时间而变化。本研究检查了这些情况的流行病学特征。
回顾了 1998 年至 2007 年期间所有被诊断为脑脓肿或硬脑膜下积脓的住院患者的病历。通过影像学研究或手术结果确诊诊断。
在 150 名患者中诊断出 151 例脑脓肿，10 例患者患有硬脑膜下积脓。脑脓肿的发病率随时间波动，而硬脑膜下积脓的发病率保持稳定。脑脓肿患者的平均年龄（+/-标准差）明显大于硬脑膜下积脓患者（48.5 +/- 19 岁 vs 25.4 +/- 24 岁；p = 0.004）。血源性脑脓肿患者的数量从 1998 年至 2002 年的 7 例增加到 2003 年至 2007 年的 19 例，而与手术相关的感染患者的数量从 10 例减少到 5 例。大多数硬脑膜下积脓与细菌性脑膜炎有关（10 例中的 4 例）。脑脓肿中有 53%确定了病因，包括肠杆菌科 spp.（21.3%）、链球菌 spp.（20%）和混合病原体（17.5%）。肺炎克雷伯菌是分离出的最常见肠杆菌（15.3%），特别是在糖尿病患者中，但在 18 岁以下儿童中未观察到。
与西方国家相比，肺炎克雷伯菌在台湾的颅内化脓性感染中起重要作用。儿童和成人的病原体和感染途径不同。
