Antibiotic impregnated catheter coverage of deep brain stimulation leads facilitates lead preservation after hardware infection

Department of Neurosurgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. Electronic address: .
Journal of Clinical Neuroscience (Impact Factor: 1.38). 07/2012; 19(10):1369-75. DOI: 10.1016/j.jocn.2012.02.008
Source: PubMed


Deep brain stimulation (DBS) has become a reliable and effective treatment for many disorders. However, the risk of long-term hardware-related complications is notable, and most concerning is hardware-related infections. Given the risk of hardware removal in the setting of infection, we retrospectively examined the implementation of a novel technique using antibiotic covered catheter protection of DBS leads after infection. The effect on hardware salvage and ease of reimplantation of the DBS extension and implantable pulse generator (IPG) was examined. A total of nine (9%) out of 100 DBS patients met the inclusion criteria with 11 DBS hardware-related infections at either the frontal, parietal, or IPG sites, from June 2003 to November 2010, at our institution. Subsequent to the initial patient in the series, a total of eight patients had placement of a short segment (approx. 4cm long) of antibiotic impregnated catheter (Bactiseal, Codman, Johnson & Johnson, Raynham, MA, USA) over the distal end of the DBS leads at the parietal incision. Seven of these eight patients presented with pus and deep tissue infections around the hardware at either the frontal, parietal, or chest incisions. In seven of these eight patients (87.5%) we were able to protect and salvage their DBS leads without need for removal. In conclusion, this novel technique provides a simple reimplantation operation, with a decreased risk of DBS lead damage. It may improve the preservation of DBS leads when hardware infection occurs, is inexpensive, and confers no additional risks to patients.

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    ABSTRACT: 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. © 2014 S. Karger AG, Basel.
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    ABSTRACT: To evaluate the feasibility and accuracy of using the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) scoring system for predicting the risk of nosocomial infection in the neurological intensive care unit (NICU), 216 patients transferred to NICU within 24hours of admission were retrospectively evaluated. Based on admission APACHE II scores, they were classified into three groups, with higher APACHE II scores representing higher infectious risk. The device utilization ratios and device-associated infection ratios of NICU patients were analyzed and compared with published reports on patient outcome. Statistical analysis of nosocomial infection ratios showed obvious differences between the high-risk, middle-risk and low-risk groups (p<0.05). The area under the receiver operating characteristic curve of the APACHE II model in predicting the risk of nosocomial infection was 0.81, which proved to be reliable and consistent with the expectation. In addition, we found statistical differences in the duration of hospital stay (patient-days) and device utilization (device-days) between different risk groups (p<0.05). Thus the APACHE II scoring system was validated in predicting the risk of nosocomial infection, duration of patient-days and device-days, and providing accurate assessment of patients' condition, so that appropriate prevention strategies can be implemented based on admission APACHE II scores.
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    ABSTRACT: INTRODUCTION. Establishing protocols of the best candidates for deep brain stimulation in patients with Parkinson's disease and a greater knowledge of the technique have increased its safety profile. Yet, the complications related with implanted devices still occur with a far-from-negligible frequency and have both an economic and clinical impact. AIM. From a broad series of patients undergoing deep brain stimulation included consecutively for the treatment of their Parkinson's disease, data concerning the complications related with implanted devices were gathered and compared with those in the literature. PATIENTS AND METHODS. Altogether 124 patients with a total of 242 implanted electrodes and 252 generator replacements were included in the study. Mean follow-up time was 8.4 years (range: 3-16 years). Data on all the complications related with implanted devices were collected retrospectively. RESULTS. Findings showed that 23 implanted device-related complications occurred (17.7% of the patients): 12 (9.6%) had culture-positive ulcers, five (4%) had culture-negative ulcers, four (3.2%) were left with infections following generator replacement, one (0.8%) had a generator malfunction, and electrode migration took place in one (0.8%). Significant differences were observed as regards the effectiveness of the treatment involving surgical revision of the ulcers, which suggests that the culture-negative ulcers responded to the surgical revision better than the culture-positive ulcers (80% healing versus 16.6%; p = 0.028). CONCLUSIONS. The results observed in the series were comparable to those in the existing literature. The presence of culture-positivity in the ulcers is a factor forecasting surgical revision.
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