Integrated infection surveillance in neurosurgery to inform patient management

We congratulate Iro et al. on their publication describing the recent increase in central nervous system abscesses and associated case-fatality in England over the last two decades. The dataset spanned 50 years and included intracranial, sub/extra dural and spinal abscesses. A paucity of published data and research exists in this area, especially at population-level and over a long time-span. The authors describe presentations predominantly in males and in infants /older adults with low mortality rates which increased with age. Likewise, we previously reported a predominance of male patients presenting with frontal lobe brain abscess in our hospital from 1988 to 2000. In-hospital mortality at that time was 9.8%, viridans streptococci were most commonly cultured and a concerning increase in meticillin-resistant Staphylococcus aureus (MRSA) infections reported.