title: Efficacy of intraoperative vancomycin powder use in intrathecal baclofen pump implantation procedures: single institutional series in a high risk population.
abstract: We aimed to assess the efficacy of intraoperative vancomycin powder in intrathecal baclofen pump placement patients, a high risk population. A retrospective review was conducted using prospectively collected data at an academic tertiary care unit. The neurosurgical adult patient population was queried for all intrathecal baclofen pump implantation procedures. Patients were then reviewed for the use of intraoperative crystalline vancomycin powder. Those with a history of prior surgical site infection, chronic systemic infections or osteomyelitis were excluded. Anhydrous, crystalline vancomycin was utilized in the wound bed after completion of implantation, distributed evenly in the case of multiple incisions. Patients received 500 mg or 1,000 mg of crystallized vancomycin, evenly distributed through the wound layers based on a 70 kg weight cutoff. Intraoperative institutional standards of infection prophylaxis were unchanged throughout the study period. Infection rate of baclofen pump placement prior to the use of vancomycin powder from 2001-2009 at the same institution was monitored. Wound infection rate was tracked for a 12 month postoperative period. Six patients out of 26 baclofen pump implantations (23%) in this cohort were identified to have seven infections despite vancomycin powder placement in the lumbar and catheter wounds. Prior infection rates have been investigated for intrathecal drug delivery systems from 2001 to 2009 at the same institution with an overall infection rate of 3% (8/274). The use of vancomycin powder in patients with implants in this series did not reduce infection rates compared to published historical controls, and was elevated compared to institutional controls. Further prospective study of this high risk patient population is warranted.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: Vismay
authors.initials: V
authors.lastname: Thakkar
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA; Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Oppenlander
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Maulucci
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Jallo
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Prasad
authors.affiliation: Department of Rehabilitation Medicine, Jefferson Medical College, Moss Rehab, Elkins Park, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Saulino
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd floor, Philadelphia, PA 19107, USA. Electronic address: Ashwini.sharan@jefferson.edu.
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001418:Baclofen / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015918:Infusion Pumps, Implantable; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage; D009128:Muscle Spasticity / Q000188:drug therapy / Q000601:surgery; D011208:Powders / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D062606:Tertiary Care Centers; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D009125:Muscle Relaxants, Central; D011208:Powders; D014640:Vancomycin; D001418:Baclofen
keywords: Baclofen pump; Infection; Pain; Spasticity; Surgical site infection; Vancomycin