Artikel
Management and treatment concepts for neuromodulation hardware-related wound infections – a nationwide survey in Germany
Management- und Behandlungskonzepte für Wundinfektionen im Zusammenhang mit Neuromodulationsgeräten: eine bundesweite Umfrage in Deutschland
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Autoren
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Pablo Andrade
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Petra Heiden
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
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Veerle Visser-Vandewalle
- Universitätsklinikum Köln, Klinik für Stereotaxie und funktionelle Neurochirurgie, Köln, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: To identify the incidence of hardware-related infections after surgical neuromodulation treatments in Germany. To depict the management and treatment algorithms of hardware-related infections currently performed in German hospitals.
Methods: A standardized questionnaire consisting of 10 multiple choice questions was sent to all affiliated members in the German Society of Neurosurgery (DGNC). Each question presented the possibility to provide additional or specific individual responses, covering the incidence, management algorithm, guidelines, diagnosis, as well as medical and surgical treatment of hardware-related infections such as spinal cord (SCS), peripheral nerve field (PNFS), sacral nerve (SNS) and deep brain stimulation (DBS).
Results: Twenty-two neurosurgical centers answered the questionnaire. The majority of centers performed between 20 to 50 neuromodulative procedures each year (54.55%). The average rate of infections was under 5% (86.36%), mostly between 2-5% of the cases (54.55%). The management and treatment of these infections is primarily performed on a case-by-case basis (77.27%), since many of the participating institutions reported the absence of specific guidelines for antibiotic or surgical management (63.64%). The main agents identified for these infections were Staphylococcus epidermidis (59.09%) and Staphylococcus aureus (40.91%). Among the antibiotics used as a first line treatment, flucloxacillin (23.52%) was the most common, followed by clindamycin, cefazolin, cefuroxime, ceftriaxone + metronidazole, and vancomycin. In almost two-thirds of the cases (61.82%) where a surgical revision was performed, the strategy was to attempt to avoid a complete explantation of the neuromodulative system.
Conclusion: Diagnostics and treatment concepts for hardware-related infections in neuromodulation are very heterogeneous in German hospitals. In particular, the antibiotic therapy applied was highly diverse among clinics. Therefore, there is an imperative necessity for comprehensive guidelines that could offer a more standardized management for this group of infections.
