title: Infections and hardware salvage after deep brain stimulation surgery: a single-center study and review of the literature.
abstract: OBJECTIVE
  Infection of hardware is a serious complication after deep brain stimulation (DBS), as this may result in additional surgery, cost and loss of treatment benefit for the patient. We report the incidence and management of infections after DBS in a single institution over the past 11 years.
  
  
  METHODS
  A database of 270 patients with 484 implants was used in the study. Incidence, clinical characteristics and management of infections were analyzed.
  
  
  RESULTS
  The overall infection rate was 9.3% (25/270) by patients and 6.8% (33/484) by episode/implants. The median time of infection after implantation was 64 days. Only 7/33 episodes (21.2%) occurred within 30 days after surgery, 22/33 episodes (66.7%) within 6 months and 28/33 episodes (84.8%) within 12 months. There was no age difference between infected and noninfected patients, while comorbidities were more frequent in the former. Infection rates before and after January 2003 were 14.3 and 4.9%, respectively. The rate of complete and partial hardware salvage was 30.3 and 21.2% while that of complete hardware removal was 48.5%. Patients with deep purulent infections and patients with Staphylococcus aureus as the causative organism were more likely to have their hardware removed.
  
  
  CONCLUSIONS
  The incidence of hardware infections declined significantly over time. Improvements in hardware and implantation techniques may be responsible. Hardware can often be completely or partly saved in infected patients.
authors.affiliation: Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Bhatia
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Oh
authors.forename: Cindy
authors.initials: C
authors.lastname: Angle
authors.forename: Donald
authors.initials: D
authors.lastname: Whiting
mesh_terms: D001921:Brain / Q000601:surgery*; D016208:Databases, Factual; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D020878:Device Removal; D004567:Electrodes, Implanted / Q000009:adverse effects*; D006801:Humans; D016459:Prosthesis-Related Infections / Q000209:etiology*; D013203:Staphylococcal Infections / Q000209:etiology*