Clinical Profile and Surgical Outcomes of Brain Abscess with Emphasis on Otogenic Etiology: A Three-Year Tertiary Care Experience

Background: Brain abscess remains a significant cause of morbidity in developing countries, with otogenic infections and trauma as predominant etiologies. This study analyzes the clinical profile, microbiological spectrum, surgical outcomes, and predictors of mortality in patients with brain abscess from a tertiary care centre in North India. Material and Methods: This hospital-based retrospective observational study included 34 surgically managed patients with brain abscess over a three-year period. Demographic variables, clinical presentation, Glasgow Coma Scale (GCS) score at admission, etiological factors, radiological characteristics, microbiological findings, operative procedures, postoperative complications, and outcomes were analyzed. Survival analysis was performed using the Kaplan–Meier method. Results: The mean age was 19.8 ± 9.4 years, with 70.6% males and 64.7% of patients below 20 years of age. The most common presenting symptoms were fever (26.5%), headache (23.5%), and ear discharge (20.6%). At admission, 76.5% of patients had GCS 13–15. Otogenic infection was the predominant etiology (58.8%), followed by trauma (35.3%). Single abscesses were present in 70.6% of patients. Staphylococcus aureus was the most frequently isolated organism (41.2%). Craniotomy with excision was performed in 94.1% of patients. Postoperative complications included wound infection (29.4%), seizures (14.7%), and hydrocephalus (14.7%). Overall mortality was 8.8%, with a 30-day survival of 91.2%. On univariate analysis, multiple abscesses (p=0.04) and low admission GCS <9 (p=0.03) were significant predictors of mortality. Conclusion: Brain abscess in this region predominantly affects young males and is largely otogenic in origin. Multiplicity of lesions and poor neurological status at admission predict mortality. Early surgical intervention combined with appropriate antimicrobial therapy yields favorable short-term survival.

Keywords: Brain abscess, Otogenic infection, Staphylococcus aureus, Craniotomy, Glasgow Coma Scale, Mortality predictors.