Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application

Miller, Jonathan P.; Acar, Feri̇dun; Burchiel, Kim J.

doi:10.3171/2008.6.17605

Cited by 53 publications

(55 citation statements)

References 32 publications

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“…In a large cohort of neurosurgical patients undergoing implantation of hardware, the infection rate was lowest (effectively zero) in those treated with local neomycin/polymixin treatment in addition to systemic antibiotics. 63 The old adage that "the solution to pollution is dilution" may hold true, although caveats exist. Local wound irrigation, particularly with detergent additives, is effective at cleansing surgical wounds.…”

Section: Antibiotic Administrationmentioning

confidence: 99%

Infection following operations on the central nervous system: deconstructing the myth of the sterile field

Walcott

Redjal²,

Coumans³

2012

FOC

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Neurosurgical patients are at a high risk for infectious sequelae following operations. For neurosurgery in particular, the risk of surgical site infection has a unique implication given the proximity of the CSF and the CNS. Patient factors contribute to some degree; for example, cancer and trauma are often associated with impaired nutritional status, known risk factors for infection. Additionally, care-based factors for infection must also be considered, such as the length of surgery, the administration of steroids, and tissue devascularization (such as a craniotomy bone flap). When postoperative infection does occur, attention is commonly focused on potential lapses in surgical “sterility.” Evidence suggests that the surgical field is not free of microorganisms. The authors propose a paradigm shift in the nomenclature of the surgical field from “sterile” to “clean.” Continued efforts aimed at optimizing immune capacity and host defenses to combat potential infection are warranted.

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Section: Antibiotic Administrationmentioning

confidence: 99%

Infection following operations on the central nervous system: deconstructing the myth of the sterile field

Walcott

Redjal²,

Coumans³

2012

FOC

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“…An infection caused by DBS hardware is one of the most serious complications [1,2,5,6,7,8], with the incidence of reported DBS-related infections ranging widely between 1.2 and 23% [1,2,3,4,8,9,10,11,12]. Although many patients with lead or internal pulse generator (IPG) pocket-associated DBS infection require device removal for clinical cure, accurate diagnosis and management of the infection may avoid the morbidity caused by DBS removal when the infection is not confirmed or is medically cured [1].…”

Section: Introductionmentioning

confidence: 99%

Reuse of Internal Pulse Generator in Cases of Infection after Deep Brain Stimulation Surgery

Göçmen

Celiker²,

Topçu³

et al. 2014

Stereotact Funct Neurosurg

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Background: Hardware-related infection after deep brain stimulation (DBS) is one of the most serious complications and may need additional interventions. Objectives: To reuse the internal pulse generator (IPG) after DBS infection and to reduce the economic costs. Methods: A database of 102 patients who underwent DBS surgery was used in the study. The incidence, clinical characteristics and management of infections while reusing the IPG after DBS-related infection were analyzed and reported. Results: The overall infection rate was 5.9% (6 of 102 patients). Management consisted of total hardware removal followed by intravenous antibiotics. The IPG was at first kept in a solution, then rinsed with water and dried following sterilization with ethylene oxide gas at 38°C for 18 h. When the treatment of the infection was finished, we reused the IPG and reimplanted the DBS. No hardware-related infection or other complications were observed after reimplantation. Conclusions: Management of hardware-related infections can be challenging. The medical and economic costs associated with these infections are enormous. The IPG can often be saved in infected patients. Thus, a significant cost burden is eliminated. Properly executed, reuse of IPG should markedly reduce the costs of these devices.

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“…2 In one of the few neurosurgical publications on this topic, Miller et al reported that local neomycin and polymyxin combined with systemic antibiotics were superior to systemic antibiotics alone in reducing stereotactic and functional hardware infection, with no associated complications. 27 We found the use of bacitracin powder to be economical and safe. The typical uses of bacitracin as a dilute wound irrigant during surgery and as a topical ointment applied to the skin have been associated with relatively few serious complications.…”

mentioning

confidence: 99%

“…Miller et al showed that the infusion of concentrated neomycin and polymyxin directly into wounds during deep brain stimulator implantation resulted in a 1.2% infection rate, which was significantly lower than the 5.7% rate reported in their historical cohort in which concentrated antibiotics were not instilled just prior to closure. 27 In this study, we evaluated the association between concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and shunt infection in a large children's hospital. We believe this is the first published report to study the effect of the direct application of a concentrated antibiotic powder to surgical wounds during cranial shunt surgery.…”

mentioning

confidence: 99%

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

Beckman

Amankwah²,

Tetreault

et al. 2015

PED

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OBJECT The application of concentrated topical antibiotic powder directly to surgical wounds has been associated with a reduction in wound infection in cardiac, spinal, and deep brain stimulator surgery. As a result of these findings, the corresponding author began systematically applying concentrated bacitracin powder directly to wounds during shunt surgery more than 5 years ago. The object of this study was to evaluate the effectiveness of concentrated bacitracin powder applied directly to wounds prior to closure during cranial shunt surgery and to evaluate the association between shunt infection and other risk factors. A single surgeon’s cranial shunt surgery experience, equally divided between periods during which antibiotic powder was and was not applied, was studied to assess the effect of concentrated bacitracin powder application on shunt infection rates. METHODS This retrospective cohort study included all patients who underwent a cranial shunting procedure at All Children’s Hospital performed by a single surgeon (G.F.T.) from 2001 to 2013. The surgeon applied bacitracin powder to all shunt wounds prior to closure between 2008 and 2013, whereas no antibiotic powder was applied to wounds prior to 2008. Both initial and revision shunting procedures were included, and all procedures were performed at a large children’s hospital (All Children’s Hospital). The primary outcome measure was shunt infection, which was defined using clinical criteria previously used by the Hydrocephalus Clinical Research Network. The association between bacitracin powder use and shunt infection was estimated using hazard ratios (HRs) and 95% CIs from Cox proportional hazard regression models. RESULTS A total of 47 infections out of 539 shunt operations occurred during the study period, resulting in an overall infection rate of 8.7%. Procedures performed before the use of concentrated bacitracin powder was instituted resulted in a 13% infection rate, whereas procedures performed after systematic use of bacitracin powder had been adopted experienced a 1% infection rate. Bacitracin powder use was associated with a reduced risk of shunt infection in univariate analysis (HR 0.11, 95% CI 0.03–0.34, p = 0.0002) and also in multivariate analysis (HR 0.12, 95% CI 0.04–0.41, p = 0.0006) when controlling for covariates that were associated with infection from the univariate analysis. The presence of a tracheostomy or a gastrostomy tube was also found to be independently associated with shunt infection in multivariate analysis (HR 3.15, 95% CI 1.05–9.50, p = 0.04, and HR 2.82, 95% CI 1.33–5.96, p = 0.007, respectively). CONCLUSIONS This study suggests, for the first time, that the systematic application of concentrated bacitracin powder to surgical wounds prior to closure during shunt surgery may be associated with a reduction in cranial shunt infection. This initial finding requires validation in a large prospective study before widespread application can be advocated.

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Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application

Abstract: Pain relief after MVD is strongly correlated with the lancinating pain component, and therefore type of TN pain is the best predictor of long-term outcome after MVD. Application of this information should be helpful in the selection of TN patients likely to benefit from MVD.

Cited by 53 publications

References 32 publications

Infection following operations on the central nervous system: deconstructing the myth of the sterile field

Infection following operations on the central nervous system: deconstructing the myth of the sterile field

Reuse of Internal Pulse Generator in Cases of Infection after Deep Brain Stimulation Surgery

Reduction in CSF shunt infection over a 10-year period associated with the application of concentrated topical antibiotic powder directly to surgical wounds prior to closure

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