Artikel
Hardware-related infections in deep brain stimulation – introduction and results of a prophylactic regime including combined systemic and local antibiotic administration
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Autoren
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Timo Behm
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen
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Veit Rohde
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen
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Kajetan von Eckardstein
- Klinik für Neurochirurgie, Universitätsmedizin Göttingen
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Deep brain stimulation (DBS) hardware infections occur up to 15% per patient and 9.7% per electrode. During complex management of these infections partial or complete explantation of DBS system frequently is required. In this respect since 04/2009 a standardized prophylactic regime containing different general steps as well as a combination of systemic and local antibiotic administration is performed at our institution. Aim of this study is to compare infection rates and management of our collective to present data.
Method: Anti-infection protocol includes general steps as for example shaving with clippers and handling of pulse generator by surgeon only. Perioperative antibiotic prophylaxis consists of preoperative "single shot" with cefazolin and in addition of local application of collagen sponges containing gentamicin, wrapped around implants (lead caps, lead extender connection, pulse generator) directly before wound enclosure. Occurrence of postoperative wound infections is retrospectively analyzed with respect to general patient data, location, affection of hardware and required treatment. Criteria for infection were clinical or microbiological evidence of wound or hardware involvement presenting within 6 months after implantation, patients with follow-up period < 6 months were excluded.
Results: Between 04/2009 and 05/2014 in 98 patients who underwent primary implantation of a DBS-system 195 leads were implanted. Median age was 62.7 years. In 89 patients lead target was (178 leads) subthalamic nucleus, in 1 patient (2) internal globus pallidus, in 7 patients (13) ventral intermediate nucleus of the thalamus and 1 (2 leads) nucleus accumbens. Wound- and hardware-infection occurred in 3 Patients (3.1%), 1 lead was involved, respectively (1.5%), leading to 1 wash out, 2 partial explantations (involved lead and extender) and 1 complete explantation. 1 extensive healing disorder over lead cap, resulting in flap surgery only, occurred. Median time to infection was 82 days. No infection of intracranial structures, extender connections or pulse generator was detected.
Conclusions: In comparison to present literature our protocol seems to be effective in reduction of hardware related infections in deep brain stimulation, especially with respect to infections of pulse generator.
