Infectious complications and optimising infection prevention for children with cochlear implants

Abstract

Aim To describe the clinical epidemiology of children receiving cochlear implants, as well as the management and outcomes of cochlear implant infections and adherence to infection prevention measures. Methods A retrospective observational study was conducted in children ≤18 years who received cochlear implants in Western Australia's tertiary paediatric hospital. Information was obtained from medical and laboratory records regarding demographics, indication for implant, implant infection and preoperative Staphylococcus aureus screening/decolonisation. Immunisation history was examined using the Australian Immunisation Register. Results Overall, 118 children received cochlear implants, with 158 devices inserted (599 cochlear implant insertion‐years). An implant infection rate of 3.8% (6/158) was identified during the study period (four pneumococcal and two community‐acquired methicillin resistant S. aureus infections). All required surgical management, with an overall median duration of antibiotic therapy of 37 days (interquartile range (IQR) 29–48) and median length of stay of 8 days (IQR 8–9.5). All devices were retained and there were no relapses or deaths. Half of the children who developed cochlear implant infections (50%, 3/6) were up‐to‐date with additional pneumococcal vaccinations and no children (0%, 0/118) received S. aureus screening/decolonisation before implant insertion. Conclusions Favourable outcomes were achieved with cochlear implant retention; however, the treatment was burdensome for families. We demonstrate significant scope to improve adherence to existing infection prevention strategies and provide direction for optimising preventative measures in the future. These include ensuring parental education, additional pneumococcal vaccinations and S. aureus decolonisation which are delivered as an infection prevention bundle to the growing population of infants receiving cochlear implants.

Electrical stimulation of cochlear implant promotes activation of macrophages and fibroblasts under inflammation

“…The surgical trauma and postoperative infection cause acute inflammation in the cochlea after CI 17,18 . The activities of immunocytes, in particular with the M1 macrophages mediate the pro‐inflammatory effect 19 .…”

“…The surgical trauma and postoperative infection cause acute inflammation in the cochlea after CI. 17,18 The activities of immunocytes, in particular with the M1 macrophages mediate the proinflammatory effect. 19 In the present study, LPS was added to mimic acute postoperative inflammation in vitro (Figure 3A under the ESCI.…”

Improving Pneumococcal Vaccination Rates in Cochlear Implant Programs: A Systematic Review and Meta‐analysis

“…A full-text review of the remaining reports excluded 10 studies, leaving 13 studies for inclusion in the final data extraction and analysis. Three studies were retrospective cohort studies, [22][23][24] 4 studies were retrospective case series, [25][26][27][28] and 6 were cross-sectional studies. [29][30][31][32][33][34]…”

“…Finally, a lack of reported patient demographics available for analysis was an additional limitation of this study. Of the 13 studies included in our analysis, only 2 included a stratification of CI patients by etiology of hearing loss, 25,28 and only 1 study stratified patients by race. 26 It would be of interest for future prospective studies to report additional demographic factors such as etiology, race, insurance status, and income level, to analyze as possible correlates to baseline pneumococcal vaccination uptake.…”

“…10 Furthermore, the data variability could also be attributed to differences in pneumococcal vaccination schedules between countries. Of the studies included in the analysis, Davidson et al 25 reported the lowest compliance rate for both PCV13 and PPSV23. This study took place in Australia, where the pneumococcal recommendations for CI patients include a standard 3-dose PCV13 series in infancy, an additional dose of PCV13 after implantation, and a single dose of PPSV23 at age 4.…”