title: Chronic Pseudomonas infections of cochlear implants.
abstract: OBJECTIVE
  To discuss chronic, refractory Pseudomonas infections of cochlear implants and their management.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Two university-based cochlear implant programs.
  
  
  METHODS
  Twenty-eight-year-old (Case 1) and 4-year-old (Case 2), different devices.
  
  
  METHODS
  Medical and surgical management.
  
  
  METHODS
  Clinical course.
  
  
  RESULTS
  Both patients had delayed presentations, 4 months and 3 years postimplantation, respectively, with fluctuating scalp edema and pain resistant to multiple courses of oral antibiotics. Infections began as localized granulation and progressed to complete encasement of both devices with rubbery, poorly vascularized tissue. In each case, two different strains of multiresistant Pseudomonas aeruginosa were cultured. Infections progressed despite local debridement and targeted antipseudomonal antibiotic coverage, and sensitive organisms continued to appear in cultures of refractory granulation tissue. Both patients underwent partial explantation, with the electrode array left in the cochlea, then received 2 to 3 more months of further medical therapy and observation and then were reimplanted successfully with new devices. Both have shown excellent performance and no sign of recurrent infection.
  
  
  CONCLUSIONS
  Infections of cochlear implants are uncommon, and cases of successful conservative management without device explantation have been reported. However, our experience and the implanted device literature suggest that chronic Pseudomonas infections may represent a distinct clinical entity, likely to fail protracted therapy and ultimately require device removal. Fortunately, successful reimplantation is possible.
authors.affiliation: Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA. germiller@email.chop.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Germiller
authors.forename: Hussam K
authors.initials: HK
authors.lastname: El-Kashlan
authors.forename: Udayan K
authors.initials: UK
authors.lastname: Shah
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D002908:Chronic Disease; D003054:Cochlear Implants / Q000382:microbiology*; D003638:Deafness / Q000534:rehabilitation*; D020878:Device Removal; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D004567:Electrodes, Implanted / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008826:Microbial Sensitivity Tests; D011474:Prosthesis Design; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity*; D012086:Reoperation; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D014774:Virulence
chemical_list: D000900:Anti-Bacterial Agents