title: Evaluation of salvage techniques for infected baclofen pumps in pediatric patients with cerebral palsy.
abstract: OBJECTIVE
  Intrathecal baclofen therapy has been used successfully for intractable spasticity in children with cerebral palsy. Infections are rare, but they are potentially life threatening if complicated by bacteremia or meningitis. Treatment without removal of the system is desirable if it can be done safely and effectively.
  
  
  METHODS
  The Authors reviewed the records of 207 patients ranging from 3 to 18 years of age with cerebral palsy who underwent placement or revision of a baclofen pump. They identified 38 patients with suspected or documented infectious complications. Initial attempts were made to eradicate infection with the devices in situ in all patients. Methods and effectiveness of pump salvage were evaluated.
  
  
  RESULTS
  Of the 38 patients identified, 13 (34.2%) had documented infections; 11 had deep wound/pocket empyemas and 2 had meningitis. Eight patients with deep wound infections received intravenous antibiotics alone. All required pump explantation. The remaining 3 patients underwent a washout procedure as well; the infection was cured in 1 patient. Both patients with meningitis received intravenous and intrathecal antibiotics, and both required device explantation. In addition, 25 patients (65.8%) had excessive or increasing wound erythema. No objective criteria to document a superficial infection were present. The wounds were considered suspicious and were managed with serial examinations and oral antibiotics. The erythema resolved in 24 of the 25 patients.
  
  
  CONCLUSIONS
  In general, observation, wound care, and oral antibiotics are sufficient for wounds that are suspicious for superficial infection. For deep-seated infection, antibiotic therapy alone is generally insufficient and explantation is required. Washout procedures can be considered, but failures are common.
authors.affiliation: Department of Neurosurgery, Medical College of Georgia, 1120 15thStreet, Augusta, GA 30912-2900, USA.
authors.forename: Sydney M
authors.initials: SM
authors.lastname: Hester
authors.forename: John F
authors.initials: JF
authors.lastname: Fisher
authors.forename: Mark R
authors.initials: MR
authors.lastname: Lee
authors.forename: Samuel
authors.initials: S
authors.lastname: Macomson
authors.forename: John R
authors.initials: JR
authors.lastname: Vender
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001418:Baclofen / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004653:Empyema / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000009:adverse effects*; D007278:Injections, Spinal / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology; D009125:Muscle Relaxants, Central / Q000008:administration & dosage*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D009125:Muscle Relaxants, Central; D001418:Baclofen