Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application.
OBJECTIVE
Hardware infection is a common occurrence after the implantation of neurostimulation and intrathecal drug delivery devices. The authors investigated whether the application of a neomycin/polymyxin solution directly into the surgical wound decreases the incidence of perioperative infection.


METHODS
Data from all stereotactic and functional hardware procedures performed at the Oregon Health & Science University over a 5-year period were reviewed. All patients received systemic antibiotic prophylaxis. For the last 18 months of the 5-year period, wounds were additionally injected with a solution consisting of 40 mg neomycin and 200,000 U polymyxin B sulfate diluted in 10 ml normal saline. The primary outcome measure was infection of the hardware requiring explantation.


RESULTS
Six hundred fourteen patients underwent hardware implantation. Among 455 patients receiving only intravenous antibiotics, the infection rate was 5.7%. Only 2 (1.2%) of 159 patients receiving both intravenous and local antibiotics had an infection. The wounds in both of these patients were compromised postoperatively: 1 patient had entered a swimming pool, and the other had undergone a general surgery procedure that exposed the hardware. If these patients are excluded from analysis, the effective infection rate using a combined intravenous and local antibiotic prophylaxis is 0%. There were no complications due to toxicity.


CONCLUSIONS
The combination of local neomycin/polymyxin with systemic antibiotic therapy can lead to a significantly lower rate of postoperative infection than when systemic antibiotics are used alone.
Miller
Jonathan P
JP
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon, USA.
Acar
Feridun
F
Burchiel
Kim J
KJ
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002437:Cefazolin / Q000008:administration & dosage; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004558:Electric Stimulation / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D015994:Incidence; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage*; D011112:Polymyxin B / Q000008:administration & dosage*; D019736:Prostheses and Implants / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013238:Stereotaxic Techniques; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D014640:Vancomycin / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D014640:Vancomycin; D009355:Neomycin; D002437:Cefazolin; D011112:Polymyxin B