Thomas Simjian1, Ivo S Muskens2, Nayan Lamba3, Ismaeel Yunusa1, Kristine Wong4, Raymond Veronneau4, Annick Kronenburg5, H Bart Brouwers5, Timothy R Smith3, Rania A Mekary1, Marike L D Broekman6. 1. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; MCPHS University, Boston, Massachusetts, USA. 2. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. 4. MCPHS University, Boston, Massachusetts, USA. 5. Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: M.L.D.Broekman-4@umcutrecht.nl.
Abstract
BACKGROUND: Dexamethasone has been used to treat cerebral edema associated with brain abscess. Whereas some argue that dexamethasone might aid antibiotic treatment, others believe that because of its immunosuppressive characteristics, it might have a negative impact on outcomes. How corticosteroid use affects overall mortality of brain abscess patients remains unclear. METHODS: A systematic search of the literature was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were utilized to identify all studies related to patients diagnosed with a brain abscess treated with dexamethasone. The main outcome of interest was mortality. Pooled effect estimates were calculated using fixed-effects (FE) and random-effects (RE) models. RESULTS: After removal of duplicates, 1681 articles were extracted from the literature of which 11 were included. These included 7 cohort studies and 4 case series. Indications to administer dexamethasone were either hospital brain abscess protocol or clinical presentation of cerebral edema. The 7 cohort studies involving 571 patients with brain abscesses comprised of 330 patients treated with standard of care (SOC) plus dexamethasone and 241 patients treated with SOC alone, after aspiration or surgical management of the abscess in either group. Pooling results from all seven cohort studies demonstrated a nonsignificant mortality benefit comparing SOC and dexamethasone patients to SOC patients (FE: risk ratio [RR], 0.94; 95% confidence interval [CI], 0.64-1.37; RE: RR, 0.95; 95% CI, 049-1.82; I2 = 53.9%; P for heterogeneity = 0.04). CONCLUSIONS: In patients with a brain abscess treated with antibiotics, the use of dexamethasone was not associated with increased mortality.
BACKGROUND:Dexamethasone has been used to treat cerebral edema associated with brain abscess. Whereas some argue that dexamethasone might aid antibiotic treatment, others believe that because of its immunosuppressive characteristics, it might have a negative impact on outcomes. How corticosteroid use affects overall mortality of brain abscesspatients remains unclear. METHODS: A systematic search of the literature was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were utilized to identify all studies related to patients diagnosed with a brain abscess treated with dexamethasone. The main outcome of interest was mortality. Pooled effect estimates were calculated using fixed-effects (FE) and random-effects (RE) models. RESULTS: After removal of duplicates, 1681 articles were extracted from the literature of which 11 were included. These included 7 cohort studies and 4 case series. Indications to administer dexamethasone were either hospital brain abscess protocol or clinical presentation of cerebral edema. The 7 cohort studies involving 571 patients with brain abscesses comprised of 330 patients treated with standard of care (SOC) plus dexamethasone and 241 patients treated with SOC alone, after aspiration or surgical management of the abscess in either group. Pooling results from all seven cohort studies demonstrated a nonsignificant mortality benefit comparing SOC and dexamethasonepatients to SOC patients (FE: risk ratio [RR], 0.94; 95% confidence interval [CI], 0.64-1.37; RE: RR, 0.95; 95% CI, 049-1.82; I2 = 53.9%; P for heterogeneity = 0.04). CONCLUSIONS: In patients with a brain abscess treated with antibiotics, the use of dexamethasone was not associated with increased mortality.