Invasive procedures and risk of brain abscess: a nationwide, population-based case-control study

It is unknown whether invasive procedures are associated with brain abscess. Nationwide, population-based, matched case–control study of patients with culture verified brain abscess in Denmark from 1989 to 2016. Exposure was invasive procedures 0–6 months before study inclusion. We identified 435 patients and 3909 controls. The level of comorbidity was higher among patients with brain abscess than among controls. A total of 48 cases (11%) had one or more invasive procedures 0–6 months before study inclusion (adjusted odds ratios (aOR) of 3.6 (95% confidence interval (CI): 2.5–5.1), a population attributable fractions of 8% (95% CI: 7–9)). In primary care, ear, nose and throat (ENT) procedures were associated with brain abscess (aOR of 4.0 (95% CI: 2.0–8.0)), but gastrointestinal endoscopies were not (aOR of 1.0 (95% CI: 0.3–3.2)). No bronchoscopies were performed in primary care. In the hospital-based setting, ENT procedures, bronchoscopies and gastrointestinal endoscopies were associated with an increased risk of brain abscess (aOR of 14.5 (95% CI: 4.8–43.8), 20.3 (95% CI: 3.8–110.1) and 3.4 (95% CI: 2.0–5.6), respectively). The association between invasive procedures and brain abscess was more pronounced in the hospital-based setting than in primary care.

目前尚不明确侵入性操作与脑脓肿是否存在关联。本研究为1989年至2016年丹麦开展的全国性基于人群的匹配病例对照研究，研究对象为经病原培养证实的脑脓肿患者。研究暴露定义为入组研究前0至6个月内接受的侵入性操作。本研究共纳入435例病例与3909例对照。脑脓肿患者的合并症负担显著高于对照组人群。共计48例病例（占比11%）在入组研究前0至6个月内接受过1次及以上侵入性操作，校正优势比（adjusted odds ratios, aOR）为3.6（95%置信区间（confidence interval, CI）：2.5~5.1），人群归因分值为8%（95% CI：7~9）。在基层医疗场景中，耳鼻喉（ear, nose and throat, ENT）操作与脑脓肿存在关联（aOR=4.0，95% CI：2.0~8.0），但胃肠内镜检查未观察到此类关联（aOR=1.0，95% CI：0.3~3.2）；基层医疗场景中未开展支气管镜检查。在医院场景中，耳鼻喉操作、支气管镜检查及胃肠内镜检查均与脑脓肿风险升高相关，对应校正优势比分别为14.5（95% CI：4.8~43.8）、20.3（95% CI：3.8~110.1）与3.4（95% CI：2.0~5.6）。侵入性操作与脑脓肿的关联在医院场景中较基层医疗场景更为显著。