Infectious complications related to intrathecal drug delivery system and spinal cord stimulator implants at a tertiary care cancer center

Koyyalagunta, Dhanalakshmi; Vinh, Baominh; Chemaly, R.; Graviss, Linda; LaFleur, Lyndsie

doi:10.1016/j.jpain.2012.01.273

Cited by 3 publications

(1 citation statement)

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“…Koyyalagunta et al (28),comparing multiple risk factors for increasing the chance of infection in SCSs, noticed that the only meaningful risk factor was the length of the surgery. Mean duration of surgery in cases with device-related infection was 215 minutes compared to 132 minutes in patients with no infection.…”

Section: Management Of Infections In These Systems Typically Involves Antibiotic Therapy and Removing The Devices (23)mentioning

confidence: 99%

Exposed Hardware: A True Contraindication for a Spinal Cord Stimulator? A Case Report and Review of the Literature

2021

PMCR

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BACKGROUND: Infection is one of the most common complications of spinal cord stimulator (SCS) implantation and causes severe morbidity for the patients and is costly for the health system and insurance. Every effort to minimize the risk of infection Post-SCS implantation has to be made. CASE REPORT: A 55-year-old man suffered right arm brachial plexus avulsion and subdural hematoma requiring a craniotomy and subsequently a cranioplasty with a metal mesh in 1998. Over the years he developed significant neuropathic pain which was controlled with a combination medication regimen until recently. In our clinic, a trial of cervical SCS showed significant improvement of pain. The consulting neurosurgeon, while evaluating his skull, noticed a very small skin defect, exposing a metal plate with no signs of infection. Based on that, he refused to implant the SCS. The patient is now seeking alternative treatment methods. CONCLUSION: Well-designed animal/human studies investigating the effects of exposed hardware for seeding infection to remote implants in the body are required to scientifically extrapolate if exposed hardware is a true contraindication for implanting an SCS or other devices in the body. KEY WORDS: Spinal cord stimulator, brachial plexus injury, complex regional pain syndrome, exposed hardware, surgical infection

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Section: Management Of Infections In These Systems Typically Involves Antibiotic Therapy and Removing The Devices (23)mentioning

confidence: 99%

Exposed Hardware: A True Contraindication for a Spinal Cord Stimulator? A Case Report and Review of the Literature

2021

PMCR

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Intrathecal Drug Delivery System Infections (Meningitis, Encephalitis, Pump Pocket Contaminants)

Beal¹

2017

Challenging Cases and Complication Management in Pain Medicine

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Biofilm-mediated antibiotic tolerance in Staphylococcus aureus from spinal cord stimulation device-related infections

Sivori,

Cavallo,

Truglio

et al. 2024

Microbiol Spectr

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Staphylococcus aureus is a predominant cause of infections in individuals with spinal cord stimulation (SCS) devices. Biofilm formation complicates these infections, commonly requiring both surgical and antibiotic treatments. This study explored the biofilm matrix composition and antimicrobial susceptibility of planktonic and biofilm-growing S. aureus isolates from individuals with SCS-related infections. Whole-genome sequencing (WGS) examined genotypes, virulome, resistome, and the pan-genome structure. The study also analyzed biofilm matrix composition, early surface adhesion, hemolytic activity, and antibiotic-susceptibility testing. WGS revealed genetic diversity among isolates. One isolate, though oxacillin susceptible, contained the mec A gene. The median number of virulence factor genes per isolate was 58. All isolates harbored the biofilm-related ica A/D genes. When assessing phenotypic characteristics, all strains demonstrated the ability to form biofilms in vitro . The antimicrobial susceptibility profile indicated that oxacillin, rifampin, and teicoplanin showed the highest efficacy against S. aureus biofilm. Conversely, high biofilm tolerance was observed for vancomycin, trimethoprim/sulfamethoxazole, and levofloxacin. These findings suggest that S. aureus isolates are highly virulent and produce robust biofilms. In cases of suspected biofilm infections caused by S. aureus , vancomycin should not be the primary choice due to its low activity against biofilm. Instead, oxacillin, rifampin, and teicoplanin appear to be more effective options to manage SCS infections. IMPORTANCE SCS devices are increasingly used to manage chronic pain, but infections associated with these devices, particularly those caused by Staphylococcus aureus , present significant clinical challenges. These infections are often complicated by biofilm formation, which protects bacteria from immune responses and antibiotic treatments, making them difficult to eradicate. Understanding the genetic diversity, virulence, and biofilm characteristics of S. aureus isolates from SCS infections is critical to improving treatment strategies. Our study highlights the need to reconsider commonly used antibiotics like vancomycin, which shows reduced activity against biofilm-growing cells. Identifying more effective alternatives, such as oxacillin, rifampin, and teicoplanin, provides valuable insight for clinicians when managing biofilm-related S. aureus infections in patients with SCS implants. This research contributes to the growing evidence that biofilm formation is crucial in treating device-related infections, emphasizing the importance of tailoring antimicrobial strategies to the biofilm phenotype.

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Infectious complications related to intrathecal drug delivery system and spinal cord stimulator implants at a tertiary care cancer center

Cited by 3 publications

References 0 publications

Exposed Hardware: A True Contraindication for a Spinal Cord Stimulator? A Case Report and Review of the Literature

Exposed Hardware: A True Contraindication for a Spinal Cord Stimulator? A Case Report and Review of the Literature

Intrathecal Drug Delivery System Infections (Meningitis, Encephalitis, Pump Pocket Contaminants)

Biofilm-mediated antibiotic tolerance in Staphylococcus aureus from spinal cord stimulation device-related infections

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