title: Gram-negative meningitis and infections in individuals treated with intrathecal baclofen for spasticity: a retrospective study.
abstract: The aim of this retrospective study was to describe signs, symptoms, and clinical outcomes of individuals undergoing intrathecal baclofen (ITB) therapy who experienced pump-related Gram-negative infections including meningitis. Participants included 12 individuals (nine males, three females) aged 10 to 32 years (mean 17y 9mo), nine of whom had quadriplegic CP. A total of 571 baclofen pump surgeries were performed with 45 total infections. Of the 45 infections, 12 were by Gram-negative organisms, two resulting in meningitis. Ten of 12 Gram-negative infections (21 site encounters) occurred within 60 days of surgery. Eleven of 12 pumps were explanted. By site encounters, Pseudomonas aeruginosa accounted for eight Gram-negative infections, Escherichia coli for five, Proteus for three, Enterobacter cloacae for two, and Klebsiella, Enterobacter aerogenes, and Enterobacter vulnaris for one each. Two individuals with Gram-negative meningitis were admitted 72 to 96 hours after hospital discharge following pump replacement. Both patients had rapid deterioration requiring transfer to the pediatric intensive care unit, and developed coagulopathy and decrease in responsiveness. Both have improved and have elected not to replace the ITB pump. In Gram-negative infections in ITB therapy, the progression of signs and symptoms can be swift and devastating. Identification of the infectious agent in such cases is imperative; these infections can quickly become life threatening.
authors.affiliation: Gillette Children's Specialty Healthcare, Department of Physical Medicine and Rehabilitation, University of Minnesota, MN, USA. cawunderlich@chva.org
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Wunderlich
authors.forename: Linda E
authors.initials: LE
authors.lastname: Krach
mesh_terms: D000293:Adolescent; D000328:Adult; D001418:Baclofen / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D002547:Cerebral Palsy / Q000188:drug therapy*; D002648:Child; D021902:Enterobacter aerogenes / Q000302:isolation & purification; D016972:Enterobacter cloacae / Q000302:isolation & purification; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects* / Q000382:microbiology*; D007278:Injections, Spinal / Q000009:adverse effects; D007709:Klebsiella / Q000302:isolation & purification; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology*; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000627:therapeutic use; D011511:Proteus / Q000302:isolation & purification; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012189:Retrospective Studies
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen