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

Abstract

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.

Lemierre’s syndrome caused by Fusobacterium necrophorum complicated with multiple brain abscesses—A case report, literature review, and suggested management

“…HBOT has been used for decades as an effective treatment in complicated infectious disease cases, by facilitating macrophage and neutrophil killing capacity in hypoxic environments such as abscesses, 17,18 and is known to potentiate the effect of some antibiotics 19 . At our institution, we have positive recent clinical experience with treating both intracranial abscesses and infected intracerebral implants with HBOT 9,11 8,9 .…”

“…A surgical intervention to drain the patient's multiple intracranial abscesses was deemed futile as: (1) diagnosis was already known and relevant antibiotic treatment initiated, and (2) the multiple abscesses were small in nature, without the possibility of significant volumetric reduction by drainage. Instead, based on previous experience 9,11 HBOT was suggested as a treatment adjunct, but not initiated since the patient showed slow improvement with reduced C‐reactive protein over the following 5 days. Nevertheless, no radiological decrease in the abscess formation was seen on an MRI performed at day 6.…”

The Role of Hyperbaric Oxygen Therapy in the Treatment of Surgical Site Infections: A Narrative Review

“…Moreover, Bartek Jr. et al applied HBOT as adjuvant treatment for hardware-related infections in neuromodulation. The findings of these studies indicated a potential benefit of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation, diminishing the need for hardware removal and treatment interruption [63].…”

The structure–function relationship ofPseudomonas aeruginosain infections and its influence on the microenvironment

“…Limited O 2 -supply in bacterial biofilms has been demonstrated in several infections, such as necrotizing soft-tissue infections (NSTI; Siemens et al 2016 ), cerebral abscesses, certain implant-related cerebral infections, refractory osteomyelitis, chronic ischemic ulcers, and pulmonary lung infections (Bartek et al 2018 , Moon 2019 ). Therefore, bacteria are subject to a hypoxic or even anoxic microenvironment affecting their sensitivity to certain types of antibiotics intended for infection control (Sønderholm et al 2017 , Jensen et al 2019b ).…”

“…The addition of extra O 2 by hyperbaric oxygen treatment (HBOT) can significantly enhance the efficacy of antibiotic treatment in vitro (Mader et al 1980 , Lima et al 2015 , Kolpen et al 2016 ) and has been shown to enhance antibiotic activity during experimental in vivo biofilm infections (Stewart et al 1999 , Kolpen et al 2016 , Özkan et al 2016 ). Biofilm infections that may become susceptible to antibiotics through the use of oxygenation include endocarditis (Özkan et al 2016 , Lerche et al 2017 ), osteomyelitis (Yu et al 2011 ), brain abscesses (Bartek et al 2016 , Kutlay et al 2005 ), and device-related infections (Bartek et al 2018 ). However, the clinical effects of HBOT treatment on infections are mainly available from pro and retrospective case-control studies (Thom 2011 ), whereas randomized, controlled trials are still lacking.…”