Deep Brain Stimulation Hardware-Related Infections: A Report of 12 Cases and Review of the Literature

Fily, Fabien; Haegelen, Claire; Tattevin, Pierre; Buffet-Bataillon, Sylvie; Revest, Matthieu; Cady, Anne; Michelet, Christian

doi:10.1093/cid/cir065

Cited by 50 publications

(43 citation statements)

References 11 publications

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“…CSF cultures that grow Staphylococcus aureus or aerobic gram-negative bacilli are indicative of infection (strong, moderate). 29. CSF cultures that grow a fungal pathogen are indicative of infection (strong, moderate).…”

Section: Neurosurgery or Head Traumamentioning

confidence: 99%

“…Deep brain stimulation, introduced in 1987 for the treatment of Parkinson's disease, is now being used for other conditions such as dystonia, essential tremor, and obsessive-compulsive disorder [29]. The stimulator consists of an intracranial lead, a connector, and a pulse generator that is implanted in the infraclavicular area [30].…”

Section: Deep Brain Stimulation Hardwarementioning

confidence: 99%

“…Treatment of deep brain stimulation-associated infections requires surgical removal of the infected components, with follow-up targeted antimicrobial therapy for 2-6 weeks [29,30].…”

Section: Evidence Summarymentioning

confidence: 99%

See 2 more Smart Citations

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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Section: Neurosurgery or Head Traumamentioning

confidence: 99%

Section: Deep Brain Stimulation Hardwarementioning

confidence: 99%

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2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

698

671

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“…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

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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.

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“…3,9 On average, DBS hardware-related infections occur in 5% of patients and the most common site for infection, although it varies, is at the connection between the DBS leads and the extension cables or at the IPG pocket. 10 Several studies have discussed the incidence, time course, and management of DBS hardware-related skin erosion [11][12][13] and superficial and DBS hardware-related infections. 10,14 Although studies have shown the effectiveness of various prophylactic antibiotic regimens 9,15 in DBS and discussed the need for complete or partial hardware removal and attempts at hardware salvage, 3,10,[16][17][18][19][20][21][22][23][24] few have demonstrated significant salvage of DBS leads in the face of infection.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic impregnated catheter coverage of deep brain stimulation leads facilitates lead preservation after hardware infection

Dlouhy

Reddy

Dahdaleh

et al. 2012

Journal of Clinical Neuroscience

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Deep Brain Stimulation Hardware-Related Infections: A Report of 12 Cases and Review of the Literature

Cited by 50 publications

References 11 publications

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

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

Antibiotic impregnated catheter coverage of deep brain stimulation leads facilitates lead preservation after hardware infection

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