BACKGROUND The aim of this study was to assess treatment outcomes in patients with cerebral abscess at a single institution based on 2 decades of experience. MATERIAL AND METHODS This study enrolled 112 patients diagnosed with cerebral abscess who underwent image-guided abscess drainage followed by antibiotic therapy between 2003 and 2023. We analyzed the patients' clinical, radiological, and laboratory parameters to identify factors associated with outcomes, as assessed by the Glasgow Outcome Scale (favorable ≥4, unfavorable <4), at discharge. In addition, we evaluated factors affecting the duration of antimicrobial administration. RESULTS Of the 112 cerebral abscess patients, 52 (46%) had predisposing factors, including contiguous or distant infection, a history of neurosurgery, or trauma. Microorganisms were isolated from 56 (50%) patients, with Streptococcus spp. being the most commonly identified (32 patients, 29%). The median duration of antimicrobial treatment was 43 days. At discharge, 87 patients (78%) had favorable outcomes, while 25 (22%) had unfavorable outcomes, including 15 deaths (13%). Poor neurological status (Glasgow Coma Scale score <13) on admission independently predicted unfavorable clinical outcomes (P=0.002). Hyperglycemia at admission was further associated with prolonged antimicrobial therapy (P=0.004), while blood glucose levels were positively correlated with the duration of antimicrobial therapy (r=0.455, P<0.001). CONCLUSIONS This study revealed that the consciousness level upon admission was related to treatment outcomes in patients with cerebral abscess. Hyperglycemia at initial presentation was also identified as an independent predictor of the need for long-term antibiotic use.