Changing of the guard: reducing infection when replacing neural pacemakers

Pepper, Joshua; Meliak, Lara; Akram, Harith; Hyam, Jonathan A.; Milabo, Catherine; Candelario, Joseph; Foltynie, Thomas; Limousin, Patricia; Curtis, Carmel; Hariz, Marwan; Zrinzo, Ludvic

doi:10.3171/2016.4.jns152934

Cited by 28 publications

(29 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our study demonstrates lower infection rates than reported historically in the literature (up to 25%) after both DBS implantation (3%) IPG replacement (0.8%) surgeries [2-5]. However, our study shows similar infection rates after implantation surgery compared to Abode-Lyamah et al [2] which reported an infection rate of 3.7% and similar infection rates after IPG replacement compared to Pepper et al [9] which had an infection rate of 0. In Abode-Lyamah et al infection rates were higher during cases without use of intra-operative vancomycin powder use (9.7% versus 3.3%) but was not statistically significant after controlling for sex [2].…”

Section: Discussionsupporting

confidence: 48%

“…Vancomycin powder use was shown to increase risk of infection after electrode implantation surgery (Relative Risk 5.5080, p = 0.02063). This is in contrast to studies that reported a decrease in infections from 8.5% to 0% after MRSA screening and treating prior to IPG replacement as well as using intra-operative vancomycin powder during surgery [9]. Atchley et al also showed that use of intra-operative vancomycin powder did not decrease infections during IPG surgery [10].…”

Section: Discussionmentioning

confidence: 67%

“…Presurgical preparation with ethyl alcohol or use of intra-operative vancomycin showed to be effective in reducing infection rates in some studies, however, the results have been inconsistent [2, 6-7]. There are conflicting studies as to whether infection rates are higher after de-novo implantation surgery or battery replacement [8-9]. The aim of this study is to evaluate the infections occurring after DBS placement and implantable generator (IPG) placement in order to better prevent and manage these infections.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infections in Deep Brain Stimulator Surgery

Bernstein

Kashyap

Ray

et al. 2019

Cureus

View full text Add to dashboard Cite

Introduction: Deep brain stimulation has emerged as an effective treatment for movement disorders such as Parkinson’s disease, dystonia, and essential tremor with estimates of >100,000 deep brain stimulators (DBSs) implanted worldwide since 1980s. Infections rates vary widely in the literature with rates as high as 25%. Traditional management of infection after deep brain stimulation is systemic antibiotic therapy with wound incision and debridement (I&D) and removal of implanted DBS hardware. The aim of this study is to evaluate the infections occurring after DBS placement and implantable generator (IPG) placement in order to better prevent and manage these infections.Materials/Methods: We conducted a retrospective review of 203 patients who underwent implantation of a DBS at a single institution. For initial electrode placement, patients underwent either unilateral or bilateral electrode placement with implantation of the IPG at the same surgery and IPG replacements occurred as necessary. For patients with unilateral electrodes, repeat surgery for placement of contralateral electrode was performed when desired. Preoperative preparation with ethyl alcohol occurred in all patients while use of intra-operative vancomycin powder was surgeon dependent. All patients received 24 hours of postoperative antibiotics. Primary endpoint was surgical wound infection or brain abscess located near the surgically implanted DBS leads. Infections were classified as early (<90 days) or late (>90 days). Infectious organisms were recorded based on intra-operative wound cultures. Number of lead implantations, IPG replacements and choice of presurgical, intra-operative, and postsurgical antibiotics were recorded and outcomes compared.Results: Two hundred and three patients underwent 391 electrode insertions and 244 IPG replacements. Fourteen patients developed an infection (10 early versus 4 late); 12 after implantation surgery (3%) and 2 after IPG replacement surgery (0.8%). No intracranial abscesses were found. Most common sites were the chest and connector. Staphylococcus aureus (MSSA) was the most common organism. Intra-operative vancomycin powder did not decrease infection risk. Vancomycin powder use was shown to increase risk of infection after electrode implantation surgery (Relative Risk 5.5080, p = 0.02063). Complete hardware removal occurred in eight patients, one patient had electrode only removal, three patients with I&D and no removal of hardware, and two patients with removal of IPG and extensor cables only. All patients were treated with postoperative intravenous antibiotics and no recurrent infections were found in patients with hardware left in place.Discussion/Conclusion: Infections after DBS implantation and IPG replacement occurred in 3% and 0.8% of patients respectively in our study which is lower than reported historically. Early infections were more common. No intracranial infections were found. Intra-operative use of vancomycin was not shown to decrease risk of infection after electrode implantation surgery or I...

show abstract

Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Infections in Deep Brain Stimulator Surgery

Bernstein

Kashyap

Ray

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…They postulated that the fibrous capsule that surrounds the IPG prevents an adequate inflammatory response to infection. But, the same group recently published a reduction in the rate of infection from 8.5% to 0% after IPG replacement when using a protocol that included screening for MRSA colonization and intraoperative, topical vancomycin/saline wash . Similar to the findings in our study, there was no increased risk of infection in replacement surgeries in the prospective cohort.…”

Section: Discussionsupporting

confidence: 88%

Subsequent Pulse Generator Replacement Surgery Does Not Increase the Infection Rate in Patients With Deep Brain Stimulator Systems: A Review of 1537 Unique Implants at a Single Center

Frizon

Hogue

Wathen

et al. 2017

Neuromodulation: Technology at the Neural Interface

View full text Add to dashboard Cite

“…Postoperative and late infections related to skin erosion are a major drawback in functional neurosurgery, since these almost always require hardware removal to obtain infection control [20, 24-30, 35, 36]. Consequently, interruption of the neuromodulation therapy and repeated surgical procedures imply suffering for patients and relatives.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric Oxygen Therapy as Adjuvant Treatment for Hardware-Related Infections in Neuromodulation

Bártek

Skyrman

Nekludov

et al. 2018

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background: In neuromodulation therapies, hardware-related infections are a major challenge often leading to hardware removal. Objective: To investigate the role of adjuvant hyperbaric oxygen therapy (HBOT) in hardware-related infections. Methods: Fourteen hardware-related infection events in 12 consecutive patients between 2002 and 2015 were treated with antibiotics and adjuvant HBOT at the Karolinska University Hospital (Stockholm, Sweden). Two time-independent infection events related to hardware replacements occurred in 2 patients. Infection resolution and the need for hardware removal were assessed. Results: Twelve out of 14 events of hardware-related infection were successfully treated without hardware removal (86%). The 2 patients treated twice with HBOT on 2 time-independent occasions could retain their hardware in both cases. Hardware was removed following HBOT failure in 2 infection events, with long-term infection control achieved in all patients. Further, an intrathecal pump malfunction caused by HBOT at 2.8 bars was observed, leading to a change in the manufacturer’s guidelines. Conclusions: This study indicates a potential benefit of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation, diminishing the need for hardware removal and treatment interruption. Prospective studies are warranted to establish the role of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation.

show abstract

Changing of the guard: reducing infection when replacing neural pacemakers

Cited by 28 publications

References 42 publications

Infections in Deep Brain Stimulator Surgery

Infections in Deep Brain Stimulator Surgery

Subsequent Pulse Generator Replacement Surgery Does Not Increase the Infection Rate in Patients With Deep Brain Stimulator Systems: A Review of 1537 Unique Implants at a Single Center

Hyperbaric Oxygen Therapy as Adjuvant Treatment for Hardware-Related Infections in Neuromodulation

Contact Info

Product

Resources

About