title: Infection following deep brain stimulator implantation performed in the conventional versus magnetic resonance imaging-equipped operating room.
abstract: OBJECTIVE
  Risk factors for deep brain stimulator (DBS) infection are poorly defined. Because DBS implants are not frequently performed in the MR imaging-equipped operating room (OR), no specific data about infection of DBS implants performed in the MR imaging environment are available in the literature. In this study the authors focus on the incidence of infection in patients undergoing surgery in the conventional versus MR imaging-equipped OR.
  
  
  METHODS
  To identify cases of DBS-associated infection, the authors performed a retrospective cohort study with nested case-control analysis of all patients undergoing DBS implantation at the University of California Los Angeles Medical Center. Cases of DBS infection were identified using standardized clinical and microbiological criteria.
  
  
  RESULTS
  Between January 1998 and September 2003, 228 DBSs were implanted. Forty-seven operations (20.6%) were performed in the conventional OR and 181 (79.4%) in the MR imaging-equipped OR. There was definite infection in 13 cases (5.7%) and possible infection in 7 cases (3%), for an overall infection rate of 8.7% (20 of 228 cases). There was no significant difference in infection rates in the conventional (7 [14.89%] of 47) versus MR imaging-equipped OR (13 [7.18%] of 181) (p = 0.7). Staphylococcus aureus was isolated in 62% of cases. Twelve of 13 confirmed cases underwent complete hardware removal. On case-control analysis, younger age (< or = 58.5 years) was a significant predictor of DBS infection (odds ratio 3.4, p = 0.027)
  
  
  CONCLUSIONS
  Infection is a serious complication of DBS implantation and commonly requires device removal for cure. The authors found that DBS implantation can be safely performed in MR imaging-equipped suites, possibly allowing improved lead placement. Young age was associated with an increased risk of DBS infection.
authors.affiliation: Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, California, USA. agorgulho@mednet.ucla.edu
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gorgulho
authors.forename: Catherine
authors.initials: C
authors.lastname: Juillard
authors.forename: Daniel Z
authors.initials: DZ
authors.lastname: Uslan
authors.forename: Katayoun
authors.initials: K
authors.lastname: Tajik
authors.forename: Poorang
authors.initials: P
authors.lastname: Aurasteh
authors.forename: Eric
authors.initials: E
authors.lastname: Behnke
authors.forename: David
authors.initials: D
authors.lastname: Pegues
authors.forename: Antonio A F
authors.initials: AA
authors.lastname: De Salles
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019072:Antibiotic Prophylaxis; D016022:Case-Control Studies; D015331:Cohort Studies; D003428:Cross Infection / Q000209:etiology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D005917:Globus Pallidus / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009873:Operating Rooms; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000209:etiology*; D020531:Subthalamic Nucleus / Q000503:physiopathology; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*