Infected CNS infusion pumps. Is there a chance for treatment without removal?
BACKGROUND
Intrathecal baclofen administration by means of an implantable pump is nowadays a safe and effective method in the treatment of spasticity. One of the rare but devastating complications of this technique is pump infection, with a variety of Gram (-) and Gram (+) organisms being involved. Treatment of these infections, according to international literature, requires removal of the device and appropriate antibiotic therapy.


METHODS
This article reports the authors experience in treating 3 patients with severe, medically intractable spasticity, suffering from infection of the intrathecally-delivering pump. A decision was made not to replace the device, but to treat this complication with pump disinfection and with a new treatment modality that has never been used before, the intra-pocket administration of antibiotics.


RESULTS
In all cases the infection was eradicated and the integrity of the pump maintained. None of the patients required a procedure under general anesthesia.


CONCLUSIONS
Removal should no longer be considered the first treatment option in infections of intrathecally delivering pumps, especially those due to non-adherent bacteria, with mild clinical symptomatology. An initial attempt should always be made for conservative treatment. Intra-pocket administration of antibiotics helps in achieving high drugs levels locally, and may prove an important element in our armamentarium against such infections.
Boviatsis
E J
EJ
Department of Neurosurgery, University of Athens Medical School, Evangelismos General Hospital, Athens, Greece. eboviats@med.uoa.gr
Kouyialis
A T
AT
Boutsikakis
I
I
Korfias
S
S
Sakas
D E
DE
D000328:Adult; D001418:Baclofen / Q000008:administration & dosage; D020878:Device Removal; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007263:Infusions, Parenteral; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy; D011552:Pseudomonas Infections / Q000209:etiology / Q000628:therapy*; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy*; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen