Infectious Complications of Intrathecal Baclofen Pump Devices in a Pediatric Population

Dickey, Michelle P.; Rice, Marilyn; Kinnett, Douglas G.; Lambert, Robin; Donauer, Stephanie; Gerber, Michael A.; Staat, Mary Allen

doi:10.1097/inf.0b013e318287f02a

Cited by 41 publications

(33 citation statements)

References 23 publications

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“…3 Few studies have investigated postoperative complication and infection rates of ITBP in the pediatric population, and findings are limited. 4,10,15 Increased mechanical complications between 1997 and 2006 were reported in 1 study. 15 Surgical-site infections (SSI) accounted for 31% of all hospital-acquired infection among hospitalized patients, according to a report by Magill et al, 8 and the overall rate of SSI reported by the National Healthcare Safety Network was 1.9%.…”

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confidence: 99%

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Pan

Kuo

Luerssen

et al. 2015

FOC

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OBJECT This study explored antibiotic prophylaxis (AP) in pediatric patients undergoing intrathecal baclofen pump (ITBP) surgery and factors associated with perioperative AP compliance with clinical guidelines. METHODS Data were obtained from the Pediatric Health Information System. The study cohort comprised patients who underwent ITBP surgery within 3 days of admission, between July 1, 2004, and March 31, 2014, with a minimum prior screening period and follow-up of 180 days. Exclusion criteria were prior infection, antibiotic use within 30 days of admission, and/or missing financial data. Chi-square tests and multivariate logistic regressions were used to determine factors associated with compliance with AP guidelines in ITBP surgeries. RESULTS A total of 1,534 patients met the inclusion criteria; 91.5% received AP and 37.6% received dual coverage or more. Overall bundled compliance comprised 2 components: 1) perioperative antibiotic administration and 2) < 24-hour postoperative antibiotic course. The most frequently used antibiotics in surgery were cefazolin (n = 873, 62.2%) and vancomycin (n = 351, 25%). Documented bundled AP compliance rates were 70.2%, 62.0%, 66.0%, and 55.2% in West, South, Midwest, and Northeast regions of the US, respectively. Compared with surgeries in the Northeast, procedures carried out in the West (OR 2.0, 95% C11.4-2.9, p < 0.001), Midwest (OR 1.6, 95% C11.1-2.3, p = 0.007), and South (OR 1.5, 95% C11.1-2.0, p = 0.021) were more likely to have documented AP compliance. Black (OR 0.74, 95% CI 0.55-1.00, p = 0.05) and Hispanic (OR 0.63, 95% CI 0.47-0.86, p = 0.004) patients were less likely to have documented AP compliance in ITBP surgeries than white patients. There were no significant differences in compliance rate by age, sex, type of insurance, and diagnosis. AP process measures were associated with shorter length of stay, lower hospitalization costs, and lower 6-month rates of surgical infection/complication. One of the 2 noncompliance subgroups, missed preoperative antibiotic administration, was correlated with a significantly higher 6-month surgical complication/infection rate (27.03%) compared with bundled compliance (20.00%, p = 0.021). For the other subgroup, prolonged antibiotic use > 24 hours postoperatively, the rate was insignificantly higher (22.00%, p = 0.368). Thus, of direct relevance to practicing clinicians, missed preoperative antibiotics was associated with 48% higher risk of adverse complication/infection outcome in a 6-month time frame. Adjusted hospitalization costs associated with baclofen pump surgery differed significantly (p < 0.001) with respect to perioperative antibiotic practices: 22.83, 29.10, 37.66 (× 1000 USD) for bundled compliance, missed preoperative antibiotics, and prolonged antibiotic administration, respectively. CONCLUSIONS Significant variation in ITBP antibiotic prophylaxis was found. Documented AP compliance was associated with higher value of care, showing favorable clinical and financial outcomes. Of most impact to clinical outcome, missed preoperative antibiotics was significantly associated with higher risk of 6-month surgical complication/infection. Prolonged antibiotic use was associated with significantly higher hospital costs compared with those with overall bundled antibiotic compliance. Future research is warranted to examine factors associated with practice variation and how AP compliance is associated with outcomes and quality, aiming for improving delivery of care to pediatric patients undergoing ITBP procedures.

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confidence: 99%

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Pan

Kuo

Luerssen

et al. 2015

FOC

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“…8,9 Although treatment failure or infection recurrence have been reported in device-related infections, particularly when the device is not removed, we found no reports in the literature of baclofen pump device infections that recurred after device removal. 2,5,10,11 We report a case of a patient with recurrent A xylosoxidans meningitis associated with an intrathecal baclofen pump device.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Commonly reported pathogens include Staphylococcus aureus (both methicillin susceptible and resistant) and coagulase-negative Staphylococcus, but Enterococcus species and gram-negative pathogens have been reported as well. [2][3]5 Depending on the extent of the infection, therapy may include systemic antibiotics and/or device removal. 6 Achromobacter xylosoxidans is an aerobic gram-negative bacillus found in the environment, particularly in water.…”

Section: Introductionmentioning

confidence: 99%

“…1 However, these devices can be associated with serious complications including infections at the pump implantation site and associated organ space infections such as meningitis. 2 Retrospective evaluations have suggested infection rates of these devices ranging from <5% up to 20%. [2][3][4] Commonly reported pathogens include Staphylococcus aureus (both methicillin susceptible and resistant) and coagulase-negative Staphylococcus, but Enterococcus species and gram-negative pathogens have been reported as well.…”

Section: Introductionmentioning

confidence: 99%

“…2 Retrospective evaluations have suggested infection rates of these devices ranging from <5% up to 20%. [2][3][4] Commonly reported pathogens include Staphylococcus aureus (both methicillin susceptible and resistant) and coagulase-negative Staphylococcus, but Enterococcus species and gram-negative pathogens have been reported as well. [2][3]5 Depending on the extent of the infection, therapy may include systemic antibiotics and/or device removal.…”

Section: Introductionmentioning

confidence: 99%

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Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent

Nichols

Knoderer

Jackson

et al. 2015

Journal of Pharmacy Practice

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Abstract:A 13-year-old female experienced a recurrence of baclofen pump-related central nervous system (CNS) infection caused by Achromobacter, despite absence of retained foreign material. Due to the failure of meropenem (120 mg/kg/d in divided doses every 8 hours and infused over 30 minutes) in the initial infection, the dose was infused over 4 hours during the recurrence. Meropenem is an antibiotic for which efficacy is time dependent, and 4-hour versus 30-minute infusions have been shown to prolong the time the concentration of the antibiotic exceeds the minimum inhibitory concentration (MIC) of the organism at the site of infection (T>MIC). Meropenem serum concentrations were obtained and indicated that T>MIC was at least 75% of the dosing interval. Our patient improved with no noted recurrences or adverse effects on the extended-infusion meropenem regimen. Utilization of extended-infusion betalactam dosing whenever possible in the treatment of serious infections caused by gram-negative organisms should be considered, as this dosing appears to be safe and improves the probability of achieving pharmacokinetic/pharmacodynamic goals.2

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Intrathecal baclofen for treating spasticity in children with cerebral palsy

Hasnat

Rice

2015

Cochrane Database of Systematic Reviews

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There is some limited short-term evidence that intrathecal baclofen is an effective therapy for reducing spasticity in children with cerebral palsy. The effect of intrathecal baclofen on long-term spasticity outcomes is less certain.The validity of the evidence for the effectiveness of intrathecal baclofen in treating spasticity in children with cerebral palsy from the studies in the review is constrained by the small sample sizes of the studies and methodological issues in some studies.Spasticity is a impairment in the domain of body structure and function. Consideration must also be given to the broader context in determining whether intrathecal baclofen therapy is effective. The aim of therapy may be, for example, to improve gross motor function, to increase participation at a social role level, to improve comfort, to improve the ease of care by others or to improve the overall quality of life of the individual. Intrathecal baclofen may improve gross motor function in children with cerebral palsy, but more reliable evidence is needed to determine this.There is some evidence that intrathecal baclofen improves ease of care and the comfort and quality of life of the individuals receiving it, but again small sample sizes and methodological issues in the studies mean that these results should be interpreted with caution.Further evidence of the effectiveness of intrathecal baclofen for treating spasticity, increasing gross motor function and improving comfort, ease of care and quality of life is needed from other investigators in order to validate these results.The short duration of the controlled studies included in this review did not allow for the exploration of questions regarding whether the subsequent need for orthopaedic surgery in children receiving intrathecal baclofen therapy is altered, or the safety and the economic implications of intrathecal baclofen treatment when long-term therapy is administered via an implanted device. Controlled studies are not the most appropriate study design to address these questions, cohort studies may be more appropriate.

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Infectious Complications of Intrathecal Baclofen Pump Devices in a Pediatric Population

Abstract: Infectious complications were relatively uncommon; however, when present, frequently led to the explantation of the ITB pump device.

Cited by 41 publications

References 23 publications

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Impact of antibiotic prophylaxis for intrathecal baclofen pump surgery in pediatric patients

Success With Extended-Infusion Meropenem After Recurrence of Baclofen Pump-Related Achromobacter Xylosoxidans Meningitis in an Adolescent

Intrathecal baclofen for treating spasticity in children with cerebral palsy

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