Reducing Intrathecal Baclofen Related Infections: Service Evaluation and Best Practice Guidelines

Abstract

Objectives: Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however infection rates have been reported in 3-26% of patients in the literature. The multidisciplinary ITB service has been established at The National Hospital for Neurology and Neurosurgery, UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the rate of infection in our ITB patient cohort and secondly, to formulate and implement best practice guidelines and to determine prospectively, whether they effectively reduced infection rates.

Intrathecal Drug Delivery: Advances and Applications in the Management of Chronic Pain Patient

“…Screening by nasal swab for staphylococcus colonization has been recommended, and, if positive, appropriate treatment with topical mupirocin is indicated. Intraoperatively, washing the pump pocket with 20ml vancomycin, 1 mg/ml along with pre-operative chlorhexidine prep, has been reportedly to markedly reduce SSI in pump exchange surgeries for intrathecal baclofen delivery (215). Placing an occlusive dressing has been recommended (64), and applying topical antibiotic may help reduce SSI (216).…”

Streptococcus dysgalactiae-related intrathecal baclofen therapy infection: how to avoid withdrawal?

“…This remains an invasive procedure that requires surgical implantation and regular filling with sterile preparation. One of the major complications is material infection [ 4 , 5 ], which generally requires urgent removal of the pump and the intrathecal catheter, with the risk of severe baclofen withdrawal. We have recently faced this problem, and proposed another management of this situation.…”