Bacteriology

Knowledge of the bacteriological sources of intracranial abscesses has improved over the past 25 years: Anaerobes account for up to 90% of the isolated bacteria, depending on the culturing technique. The fact that (in the past) several studies (e.g. Yang 19813) found a high percentage of sterile cultures may be deceptive. One explanation may be that anaerobic culturing either had not been done or had not been successful.

Brook32 reported the differential bacteriological findings in 19 children with intracranial abscesses as follows: in 63.2 %, anaerobes were cultured exclusively; in 26.3 % both aerobes and anaerobes were found; and only 10.5 % of the cultures were purely aerobic. Typically, several microorganisms were found simultaneously.

These results are consistent with our own (table 2.2.5-2 and 2.2.5-3): In 21 sequential patients, 32 microorganisms were identified. Nine patients had more than one organism cultured from the intracranial focus. In 15 patients, the cultures were purely anaerobic, including micro-aerophilic streptococci. In 5 patients, staphylococci were found, mostly in combination with other microorganisms.

The therapeutic effects of HBO on anaerobic and mixed aerobic/anaerobic flora are well known, and delineated33-37.

Table 2.2.5-2. Bacterial isolated (own patient series, N = 21): In 15 patients exclusively anaerobic/microaerophilic pathogens, in 9 patients more than one germ isolated Strictly anaerobic Peptostreptococci 6

Bacteroides spp. 4 53 %

Fusobacteria 2

Clostridium perfringens 1

Veillonella 1

Streptococci (anaerobic) 3

Table 2.2.5-2. Bacterial isolated (own patient series, N = 21): In 15 patients exclusively anaerobic/microaerophilic pathogens, in 9 patients more than one germ isolated Strictly anaerobic Peptostreptococci 6

Bacteroides spp. 4 53 %

Fusobacteria 2

Clostridium perfringens 1

Veillonella 1

Streptococci (anaerobic) 3

Intermediate

Streptococci

9

(microaerophilic)

31 %

Enterobacter

1

Aerobic

Staphylococci spp.

5

16 %

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