title: Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation.
abstract: BACKGROUND
  Deep brain stimulation has been performed at the Department of Neurosurgery, Aarhus University Hospital (AUH), for 16 years. The risk of infection related to implantable pulse generator (IPG) replacement constitutes a weakness in the long-term DBS treatment.
  
  
  OBJECTIVE
  The aim of this study is to investigate the association between risk of infection and number of IPG replacements.
  
  
  METHODS
  All patients who underwent IPG replacement at the AUH from June 1996 until September 2012 were included in the study, and their medical records were systematically reviewed. The data was analyzed using Fisher's exact test on contingency tables.
  
  
  RESULTS
  220 procedures of IPG replacement were completed on 105 patients who suffered from various movement disorders. Up to 5 IPG changes were registered in a single patient. Thirteen patients incurred infection requiring surgical intervention. Testing for risk of infection associated with number of IPG changes, this study found significantly different infection rates (p = 0.0052). In the groups with 3 and 4 IPG changes, infection rates reached over 20%.
  
  
  CONCLUSIONS
  This study found significantly different rates of infection related to the number of IPG changes. Further investigation and resources should be directed towards improving the lifespan of IPGs.
authors.affiliation: Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Jens F
authors.initials: JF
authors.lastname: Thrane
authors.forename: Niels A
authors.initials: NA
authors.lastname: Sunde
authors.forename: Bo
authors.initials: B
authors.lastname: Bergholt
authors.forename: Frederikke
authors.initials: F
authors.lastname: Rosendal
mesh_terms: D000368:Aged; D002494:Central Nervous System Infections / Q000453:epidemiology* / Q000209:etiology; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D058542:Implantable Neurostimulators / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies