Intensive multidisciplinary care crucial in paediatric intracranial abscess management: study

Intracranial abscesses in paediatric patients, although rare, need intensive multidisciplinary care, suggests a study, noting significant heterogeneity in current treatment strategies.

“Molecular testing substantially enhances diagnostic yield and pathogen identification,” the researchers said. “Radiologic structural sequelae are common, but their prognostic significance remains unclear.”

Twenty-six children were included in this study, of whom 17 had brain abscesses, seven subdural empyemas, and two epidural empyemas. Twenty-one patients (81 percent) were found to have pathogens, with 23 isolates. Ten of the 23 isolates (43 percent) were detected exclusively by real-time polymerase chain reaction.

Half of the patients received intravenous therapy for <6 weeks with no recurrence, including 35 percent of brain abscesses. Those undergoing drainage/craniotomy showed larger lesions (p=0.04) and needed longer intravenous treatment than conservatively managed children (42 vs 20 days; p=0.022).

Residual findings were observed during radiologic follow-up in most patients (60 percent). Sadly, one child died, and 15 percent of patients experienced neurologic sequelae.

The researchers reviewed the clinical charts of a tertiary care paediatric hospital in Italy from 2017 to 2025. They included children aged <18 years who had been diagnosed with brain abscess or subdural/epidural empyema and collected clinical, radiologic, microbiologic, and immunologic treatment and outcome data. The Mann‒Whitney U test and Fisher exact test were used for comparisons.

“Standardized paediatric protocols and well-designed prospective studies are needed to optimize antimicrobial stewardship, define which candidates may safely receive shorter intravenous courses, and harmonize follow-up imaging,” the researchers said.