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Abstract

ABSTRACT
Introduction. Microbiological yield in intracranial suppurative infections (ISI) is low in resource-limited settings, where empirical antibiotics often precede sampling. We quantified this yield, sought factors associated with culture positivity, and assessed the adequacy of empirical therapy against isolated organisms. Methods. Secondary analysis of a single-centre cohort of 150 episodes (148 patients; 2016–2026, Bouaké Teaching Hospital, Côte d’Ivoire). Factors associated with positivity were examined among sampled patients (n = 116; 50 events) using Firth penalized logistic regression with internal bootstrap validation. Adequacy was assessed both by recorded in-vitro activity against the antibiogram and by a prespecified expert classification of expected spectrum-based coverage. Results. Pus was sampled in 77.3 % of episodes; cultures were positive in 50/116 sampled patients (43.1 %; 95 % CI 34.5–52.2) and in 33.3 % of the cohort. Gram-positive cocci predominated (82 %): streptococci 42 %, Staphylococcus aureus 34 %. No prespecified factor was associated with positivity; only continuous age was (aOR 1.23 per decade; 95 % CI 1.03–1.48), without usable discrimination (corrected AUC 0.58–0.61). Initial therapy included at least one in-vitro-active agent in 34/44 episodes with an antibiogram (77.3 %); expected spectrum-based coverage was 74–76 % but showed no individual concordance with the antibiogram (kappa −0.04). The main gap concerned S. aureus (53 % covered). Two-thirds of the cohort (100/150) were treated without an exploitable isolate; 93 % of regimens contained a WHO “Watch” antibiotic. Conclusion. Routine variables did not identify culture-positive episodes, arguing for deep sampling whenever feasible rather than clinical selection. Empirical therapy was broadly adequate, antistaphylococcal coverage being the one easily correctable weakness. Strengthening microbiological capacity and structured stewardship is the priority.
RÉSUMÉ
Introduction. Le rendement microbiologique des suppurations intracrâniennes (SIC) est faible dans les contextes de ressources limitées, où l’antibiothérapie probabiliste précède souvent le prélèvement. Nous avons quantifié ce rendement, recherché les facteurs associés à une culture positive et évalué l’adéquation de l’antibiothérapie probabiliste vis-à-vis des germes isolés. Méthodes. Analyse secondaire d’une cohorte monocentrique de 150 observations (148 patients ; 2016–2026, CHU de Bouaké). Les facteurs associés à la positivité ont été recherchés parmi les patients prélevés (n = 116 ; 50 événements) par régression logistique pénalisée de Firth, avec validation interne par bootstrap. L’adéquation a été évaluée par l’adéquation enregistrée vis-à-vis de l’antibiogramme et par une classification experte préspécifiée de la couverture attendue selon le spectre. Résultats. Un prélèvement était réalisé dans 77,3 % des cas ; les cultures étaient positives chez 50/116 patients prélevés (43,1 % ; IC95 % 34,5–52,2). Les cocci à Gram positif prédominaient (82 %) : streptocoques 42 %, Staphylococcus aureus 34 %. Aucun facteur préspécifié n’était associé à la positivité ; seul l’âge en continu l’était (ORa 1,23 par décennie ; IC95 % 1,03–1,48), sans discrimination exploitable (AUC corrigée 0,58–0,61). L’adéquation vis-à-vis de l’antibiogramme était de 77,3 % (34/44) ; la couverture attendue selon le spectre était de 74–76 % mais sans concordance individuelle (kappa −0,04). La principale faille concernait S. aureus (couvert dans 53 %). Deux tiers de la cohorte (100/150) ont été traités sans isolat exploitable ; 93 % des schémas comportaient un antibiotique « Watch » de l’OMS. Conclusion. Les variables de routine ne permettaient pas d’identifier les épisodes à culture positive, ce qui plaide pour un prélèvement profond chaque fois qu’il est techniquement possible plutôt que pour une sélection clinique. L’antibiothérapie probabiliste était globalement adéquate, la couverture antistaphylococcique constituant le seul point faible aisément corrigeable. Le renforcement des capacités microbiologiques et des programmes structurés de bon usage des antibiotiques apparaît prioritaire.

Keywords

Intracranial suppuration; Brain abscess; Microbiological yield; Empirical antibiotic therapy; Antimicrobial stewardship; Antimicrobial resistance; Sub-Saharan Africa Suppuration intracrânienne ; Abcès cérébral ; Rendement microbiologique ; Antibiothérapie probabiliste ; Bon usage des antibiotiques ; Antibiorésistance ; Afrique subsaharienne

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How to Cite
Fionko YB, Teti FSL, Dongo KYS, Yao KS, Keke KJB, Kouassi KJJ, … Haidara A. (2026). Microbiological yield, Factors Associated with Culture Positivity, and Coverage of Empirical Antibiotic Therapy in Intracranial Suppurative Infections: A Ten-Year Ivorian Cohort: Rendement Microbiologique, Facteurs Associés à la Positivité des Cultures et Couverture de l’Antibiothérapie Empirique dans les Infections Suppurées Intracrâniennes : Une Cohorte Ivoirienne sur Dix Ans. HEALTH SCIENCES AND DISEASE, 27(10), 81–89. https://doi.org/10.67260/hsd.v27i10.7921
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