Bacteriology of intracranial abscess in children.

The bacteriological and clinical findings in 19 pediatric patients with intracranial abscess are presented. Ten children presented with subdural empyema and nine had brain abscess. Sinusitis was present in 14 children, and dental abscess in two. The abscess was located in the frontal and parietal area in seven instances each, and in the temporal area in five. Anaerobic organisms alone were recovered in 12 (63%) of the patients (including eight with subdural empyema and four with brain abscess), aerobic bacteria alone were present in two children (11%), and mixed aerobic and anaerobic bacteria were present in five (26%) patients. There were 43 anaerobic isolates (2.3 per specimen). The predominant anaerobes were anaerobic Gram-positive cocci (16 isolates); Bacteroides sp. (10, including two B. fragilis); Fusobacterium sp. (nine isolates); and Actinomyces sp. (five isolates). A total of eight aerobic isolates (0.4 per specimen), including five Gram-positive cocci and three Haemophilus sp., were recovered. Antimicrobial therapy was administered to all patients. Five patients, four with sinusitis and subdural empyema and one with sinusitis and brain abscess, did not respond to antimicrobial therapy and aspiration of the abscess, and required surgical drainage of their inflamed sinuses. These findings indicate the major role of anaerobic organisms in the polymicrobial etiology of intracranial abscess in children.