title: Risk factors for baclofen pump infection in children: a multivariate analysis.
abstract: OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Heather S
authors.initials: HS
authors.lastname: Spader
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Bollo
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bowers
authors.affiliation: Department of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah.
authors.forename: Jay
authors.initials: J
authors.lastname: Riva-Cambrin
mesh_terms: D000293:Adolescent; D001418:Baclofen / Q000008:administration & dosage / Q000009:adverse effects*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016503:Drug Delivery Systems / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D015999:Multivariate Analysis; D009125:Muscle Relaxants, Central / Q000009:adverse effects*; D009422:Nervous System Diseases / Q000188:drug therapy / Q000601:surgery; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: BMI = body mass index; ITB = intrathecal baclofen; PCH = Primary Children's Hospital; TBI = traumatic brain injury; VP = ventriculoperitoneal; baclofen pump; children; infection; spasticity