Deep brain stimulation hardware–related infections: 10-year experience at a single institution

Abstract

OBJECTIVE Deep brain stimulation is an effective surgical treatment for managing some neurological and psychiatric disorders. Infection related to the deep brain stimulator (DBS) hardware causes significant morbidity: hardware explantation may be required; initial disease symptoms such as tremor, rigidity, and bradykinesia may recur; and the medication requirements for adequate disease management may increase. These morbidities are of particular concern given that published DBS-related infection rates have been as high as 23%. To date, however, the key risk factors for and the potential preventive measures against these infections remain largely uncharacterized. In this study, the authors endeavored to identify possible risk factors for DBS-related infection and analyze the efficacy of prophylactic intrawound vancomycin powder (VP). METHODS The authors performed a retrospective cohort study of patients who had undergone primary DBS implantation at a single institution in the period from December 2005 through September 2015 to identify possible risk factors for surgical site infection (SSI) and to assess the impact of perioperative (before, during, and after surgery) prophylactic antibiotics on the SSI rate. They also evaluated the effect of a change in the National Healthcare Safety Network's definition of SSI on the number of infections detected. Statistical analyses were performed using the 2-sample t-test, the Wilcoxon rank-sum test, the chi-square test, Fisher's exact test, or logistic regression, as appropriate for the variables examined. RESULTS Four hundred sixty-four electrodes were placed in 242 adults during 245 primary procedures over approximately 10.5 years; most patients underwent bilateral electrode implantation. Among the 245 procedures, 9 SSIs (3.7%) occurred within 90 days and 16 (6.5%) occurred within 1 year of DBS placement. Gram-positive bacteria were the most common etiological agents. Most patient- and procedure-related characteristics did not differ between those who had acquired an SSI and those who had not. The rate of SSIs among patients who had received intrawound VP was only 3.3% compared with 9.7% among those who had not received topical VP (OR 0.32, 95% CI 0.10-1.02, p = 0.04). After controlling for patient sex, the association between VP and decreased SSI risk did not reach the predetermined level of significance (adjusted OR 0.32, 95% CI 0.10-1.03, p = 0.06). The SSI rates were similar after staged and unstaged implantations. CONCLUSIONS While most patient-related and procedure-related factors assessed in this study were not associated with the risk for an SSI, the data did suggest that intrawound VP may help to reduce the SSI risk after DBS implantation. Furthermore, given the implications of SSI after DBS surgery and the frequency of infections occurring more than 90 days after implantation, continued follow-up for at least 1 year after such a procedure is prudent to establish the true burden of these infections and to properly treat them when they do occur.

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

“…After screening titles and abstracts, 479 potentially relevant articles were identified, and the full text was assessed against the inclusion criteria. Finally, 240 articles were chosen to be included in this meta‐analysis …”

Infections in Deep Brain Stimulator Surgery

“…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 [1-2]. The applications of DBS continue to increase as it is now approved by the U.S. Food and Drug Administration (FDA) for epilepsy, and there are many reports of its efficacy in psychiatric disorders and pain syndromes [1].…”

“…The applications of DBS continue to increase as it is now approved by the U.S. Food and Drug Administration (FDA) for epilepsy, and there are many reports of its efficacy in psychiatric disorders and pain syndromes [1]. Infection rates vary widely in the literature with rates as high as 25% [2-5]. Traditional management of DBS infections is systemic antibiotic therapy with wound incision and debridement (I&D) and removal of implanted DBS hardware [2, 4-5].…”

“…Infection rates vary widely in the literature with rates as high as 25% [2-5]. Traditional management of DBS infections is systemic antibiotic therapy with wound incision and debridement (I&D) and removal of implanted DBS hardware [2, 4-5]. Removal of a DBS can be very devastating for patients and sometimes infections can be managed without removal of hardware [4-5].…”

“…Removal of a DBS can be very devastating for patients and sometimes infections can be managed without removal of hardware [4-5]. 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].…”