title: The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure.
abstract: OBJECTIVE
  Infection of implanted hardware after deep brain stimulation (DBS) has a significant impact on patient morbidity. We examined all patients who underwent DBS procedures over the last 9 years in our centre to assess the infection rate and possible factors related to surgery that may predispose to infection.
  
  
  METHODS
  Surgical reports and clinical notes were reviewed in 273 consecutive patients who underwent a total of 519 DBS-related procedures in our institute between November 2002 and September 2011.
  
  
  RESULTS
  Sixteen separate hardware-related infections occurred in 11 patients. Infections occurred in 3% of all procedures and 4% of all patients. The infection rate after implantable pulse generator (IPG) replacement surgery was more than three times higher than after de novo DBS surgery. In addition, male patients were more likely to develop device-related infections.
  
  
  CONCLUSIONS
  It is unclear why infection rates should be more than three times higher after IPG replacement surgery than after the de novo procedure. The former is a shorter and simpler procedure to conduct. Perhaps the use of better antimicrobial protection and rechargeable batteries may be useful strategies to reduce infections following IPG revision surgery.
authors.affiliation: Unit of Functional Neurosurgery, UCL Institute of Neurology, London, UK.
authors.forename: Joshua
authors.initials: J
authors.lastname: Pepper
authors.forename: Ludvic
authors.initials: L
authors.lastname: Zrinzo
authors.forename: Bilal
authors.initials: B
authors.lastname: Mirza
authors.forename: Thomas
authors.initials: T
authors.lastname: Foltynie
authors.forename: Patricia
authors.initials: P
authors.lastname: Limousin
authors.forename: Marwan
authors.initials: M
authors.lastname: Hariz
mesh_terms: D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D001922:Brain Abscess / Q000453:epidemiology / Q000382:microbiology; D002177:Candidiasis / Q000209:etiology; D015897:Comorbidity; D046690:Deep Brain Stimulation / Q000009:adverse effects* / Q000295:instrumentation; D020878:Device Removal / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D004660:Encephalitis / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D004866:Equipment Contamination; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013203:Staphylococcal Infections / Q000209:etiology; D055815:Young Adult