E. coli Brain Abscesses

Pathogenesis and Epidemiology

The European Society of Clinical Microbiology and Infectious Diseases reports that brain abscesses have an estimated incidence of 0.4-1.3 per 100,000 inhabitants per year in Europe 3
The Infectious Diseases Society of America notes that E. coli brain abscesses can occur, especially in situations such as after neurosurgical procedures 4, 5
The European Society of Clinical Microbiology and Infectious Diseases states that E. coli brain abscesses can also occur in patients with immunosuppression 3
The American Heart Association reports that E. coli brain abscesses can occur in patients with bacteremia or endocarditis 6

The European Society of Clinical Microbiology and Infectious Diseases recommends MRI with DWI/ADC and T1-weighting with and without gadolinium as the preferred method for diagnosing brain abscesses; alternatively, contrast-enhanced CT can be used 7, 5
The Infectious Diseases Society of America notes that microbiological diagnosis requires aspiration or excision of the abscess with subsequent culture and molecular biological diagnosis 7, 1

The European Society of Clinical Microbiology and Infectious Diseases strongly recommends neurosurgical aspiration or excision of the brain abscess as early as possible 7, 5
The European Society of Clinical Microbiology and Infectious Diseases recommends empirical therapy with a third-generation cephalosporin combined with metronidazole for the empirical treatment of community-acquired brain abscesses 7, 5
The European Society of Clinical Microbiology and Infectious Diseases states that the duration of therapy should be 6-8 weeks of intravenous antibiotics for aspirated or conservatively treated brain abscesses; a shorter duration (e.g., 4 weeks) may be considered after excision 7, 5

The European Society of Clinical Microbiology and Infectious Diseases recommends the use of corticosteroids in cases of severe symptoms due to perifocal edema or impending herniation 7, 5
The European Society of Clinical Microbiology and Infectious Diseases does not routinely recommend prophylactic antiepileptic treatment 7, 5
The European Society of Clinical Microbiology and Infectious Diseases states that antibiotics should be withheld until aspiration or excision has been performed, unless there is a severe underlying disease and neurosurgical intervention can be performed within 24 hours 7, 5