A decade-long silence: unveiling a case series of Enterococcus avium brain abscess

Background Enterococcus avium is an extremely rare aetiological agent of brain abscess, with only a limited number of cases reported to date. Early diagnosis and timely antimicrobial therapy are essential because of the potential for significant morbidity and neurological sequelae.Methods We present a case series of patients diagnosed with E. avium brain abscess following neurosurgical evaluation for progressive neurological symptoms. Clinical, radiological, microbiological, antimicrobial susceptibility, treatment, and outcome data were reviewed.Results All patients had radiological evidence of focal intracranial abscess formation, with microbiological confirmation of E. avium from abscess specimens. In most cases, empirical antimicrobial therapy did not result in an adequate clinical response, highlighting the importance of targeted antibiotic selection based on culture and antimicrobial susceptibility testing. Surgical drainage combined with appropriate antimicrobial therapy resulted in a favourable outcome in the majority of patients.Conclusions Accurate species-level identification and antimicrobial susceptibility testing are important when E. avium is isolated from brain abscess specimens. These investigations facilitate appropriate antimicrobial selection and may contribute to improved clinical management and outcomes.