# Perspectives in Brain Abscess Diagnosis and Management: A National Survey of Infectious Disease Specialists

## TL;DR

This study surveyed US infectious disease specialists to understand current practices and identify gaps in brain abscess care, highlighting the need for standardized guidelines.

## Contribution

The paper provides insights into US-specific brain abscess management practices and emphasizes the need for formal guidelines.

## Key findings

- Most specialists use a combination of third-generation cephalosporin, metronidazole, and vancomycin for empiric treatment.
- There is significant variation in the use of molecular diagnostics and transition to oral antibiotics.
- 91% of respondents support the development of formal brain abscess management guidelines.

## Abstract

Variability in causative agents, host factors, and management complexity and the lack of clear guidelines in the United States hinder the standardization of brain abscess (BA) care. This survey examines US infectious disease (ID) specialists’ perspectives on BA care, comparing practice settings and identifying key areas for future studies and guideline development.

A multidisciplinary team of neurologists and ID physicians developed a 10-item online survey that was validated via a focus group and distributed to 1486 ID specialists in the Infectious Diseases Society of America's Emerging Infections Network from 7 September to 2 October 2023.

Of the 551 respondents (37% response rate), 116 (21%) opted out due to noninvolvement in BA cases, leaving 435 completed surveys. The most common empiric treatment (53%) consisted of third-generation cephalosporin, metronidazole, and vancomycin. Imaging at treatment completion was supported by 67%, and 75% recommended a 6- to 8-week intravenous antibiotic course. Neurosurgical intervention was primarily pursued to identify pathogens and confirm the diagnosis. Molecular diagnostics were variably used, with broad-spectrum polymerase chain reaction being the most commonly utilized test. Transitioning to oral antibiotics before 6 weeks was favored by 40%, while only 18% recommended postintravenous oral consolidation therapy. Notably, 91% endorsed the need for BA management guidelines.

This study highlights a lack of consensus and significant variations in BA management, suggesting that current practices rely heavily on expert opinion rather than standardized protocols. These findings emphasize the need for further studies and US-specific guidelines to complement efforts of the European Society of Clinical Microbiology and Infectious Diseases and establish a more comprehensive, globally applicable standard of care.

This survey of 435 infectious disease physicians highlighted significant differences in brain abscess management, including varied antibiotic regimens and diagnostic approaches. Most respondents emphasized the need for formal guidelines to provide clearer recommendations on treatment duration and other management strategies.