CASE REPORT article
Front. Pharmacol.
Sec. Neuropharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1506879
Case report：Analysis of the efficacy and safety of anti-infectious treatment for brain abscess caused by oral anaerobes
Provisionally accepted
- 1Department of Pharmacy, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- 2Department of Pharmacy, Urumqi First People's Hospital (Urumqi Children's Hospital), Urumqi, China
- 3Department of Clinical Laboratory, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- 4Department of Anesthesiology and SICU, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Anaerobic meningitis is relatively rare, and the positivity rate of cerebrospinal fluid (CSF) cultures is exceedingly low, particularly in light of the limited research data regarding bacterial meningitis caused by oral anaerobes. This report presents a case involving a 24-year-old woman who developed fever and headache 32 days after undergoing a cesarean section. The symptoms persisted for two weeks, and enhanced nuclear magnetic resonance (NMR) scanning confirmed the suspicion of a brain abscess.Additionally, metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) identified several microbial species, including Porphyromonas gingivalis, Prevotella heparinolyticus, Fusobacterium nucleatum, Parvimonas micra and Filifactor alocis. Bacterial culture of CSF revealed the growth of Prevotella heparinolyticus. Following bilateral ventricular external drainage, intracranial lesion resection, and the implantation of an Ommaya reservoir in the right lateral ventricle, cranial decompression treatment was performed. Antimicrobial therapy administered successively over a period of six weeks, including vancomycin, meropenem, metronidazole, polymyxin B and ceftazidime, resulting in significant control of the infection. Clinical pharmacists engaged in comprehensive discussions with clinicians regarding the antimicrobial drug regimens and recommended a combined regimen of meropenem and metronidazole. An individualized anti-infective treatment protocol was developed based on therapeutic drug monitoring (TDM), which is anticipated to yield valuable insights for the management of brain abscesses resulting from oral anaerobic bacteria.
Keywords: Oral anaerobes, Brain Abscess, metagenomic next-generation sequencing, Metronidazole, Meropenem
Received: 08 Oct 2024; Accepted: 24 Apr 2025.
Copyright: © 2025 Tian, Liu, Chen and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhiyu Chen, Department of Anesthesiology and SICU, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
Lixia Li, Department of Pharmacy, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, China
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