Streptococcal brain abscesses: assessing a decade of trends in England between 2014 and 2023 — ASN Events
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  3. Streptococcal brain abscesses: assessing a decade of trends in England between 2014 and 2023

Streptococcal brain abscesses: assessing a decade of trends in England between 2014 and 2023 (#124)

Rebecca L Guy 1 , Kartyk Moganeradj 1 , Eliza Gil 2 3 , Nurfarah Sabtu 4 , Colin S Brown 1 , Mariyam Mirfenderesky 1 , Theresa Lamagni 1
  1. UK Health Security Agency, London, LONDON, United Kingdom
  2. University College London, London, United Kingdom
  3. London School of Hygiene and Tropical Medicine, London, United Kingdom
  4. University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom

Background

Following anecdotal domestic and international reports of post-pandemic increases streptococcal brain abscess incidence,[1] we investigated trends, patient demographics and microbial aetiology of hospital admissions for brain abscesses in England.

Methods

National patient admission data were extracted from England’s hospital admission database[2] for 2014-2023 records with a brain abscess ICD10-code (G06.0/G06.2). Positive microbiological specimens were identified via linkage to the UKHSA national laboratory surveillance database.[3] Preliminary descriptive statistics were performed to investigate factors associated with streptococcal brain abscess.

Results

Between 2014-2023, 11,011 brain abscess admissions were identified from 8,553 (77.7%) adults (≥18yrs), 1,482 (13.5%) children (1-17yrs), and 296 (2.7%) infants (<1yr; missing age=680).

Where microbiology was available (n=7,324), 30% were streptococcal species (26% adults, 51% children, 38% infants), increasing from 23% (n=146) in 2014 to 35% (n=383) in 2023.

The age-adjusted odds of having a streptococcal species brain abscess in patients of white ethnicity was 1.6 times higher (p<0.001), compared to Asian patients where non-streptococcal species were more likely.

Streptococcus intermedius was the most frequently identified streptococcal species in adults (54%, n=1,179) and children (63%, n=458), whereas Streptococcus pneumoniae was the most common for infants (55%, n=45)

The overall 90-day all-cause case fatality rate for streptococcal brain abscess cases was 8.5% (95% CI 7.5-9.5%); adults: 10.9%, children: 1.8%, infants: 2.4%.

Conclusions

Our study showed a marked increase in streptococcal brain abscess incidence in England since 2014 The microbial aetiology differed by age and ethnicity. Differences between surgical and community-acquisition and predisposing conditions need to be assessed to identify prevention opportunities.

  1. Accorsi EK, Chochua S, Moline HL, Hall M, Hersh AL, Shah SS, et al. Pediatric Brain Abscesses, Epidural Empyemas, and Subdural Empyemas Associated with Streptococcus Species — United States, January 2016–August 2022. MMWR Morb Mortal Wkly Rep [Internet]. 2022 Sep 16;71(37):1169–73. Available from: http://www.cdc.gov/mmwr/volumes/71/wr/mm7137a2.htm?s_cid=mm7137a2_w
  2. NHS England. Hospital Episode Statistics (HES) [Internet]. 2023. Available from: https://digital.nhs.uk/data-and-information/data-tools-and-services/dataservices/hospital-episode-statistics
  3. UK Health Security Agency. Laboratory reporting to UKHSA: a guide for diagnostic laboratories [Internet]. London; 2023. Available from: https://assets.publishing.service.gov.uk/media/647749ce5f7bb700127fa25a/UKHSA_Laboratory_reporting_guidelines_May_2023.pdf
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