Changing of the guard: reducing infection when replacing neural pacemakers.
OBJECTIVE Infection of deep brain stimulation (DBS) hardware has a significant impact on patient morbidity. Previous experience suggests that infection rates appear to be higher after implantable pulse generator (IPG) replacement surgery than after the de novo DBS procedure. In this study the authors examine the effect of a change in practice during DBS IPG replacements at their institution. METHODS Starting in January 2012, patient screening for methicillin-resistant Staphylococcus aureus (MRSA) and, and where necessary, eradication was performed prior to elective DBS IPG change. Moreover, topical vancomycin was placed in the IPG pocket during surgery. The authors then prospectively examined the infection rate in patients undergoing DBS IPG replacement at their center over a 3-year period with at least 9 months of follow-up. RESULTS The total incidence of infection in this prospective consecutive series of 101 IPG replacement procedures was 0%, with a mean follow-up duration of 24 ± 11 months. This was significantly lower than the authors' previously published historical control group, prior to implementing the change in practice, where the infection rate for IPG replacement was 8.5% (8/94 procedures; p = 0.003). CONCLUSIONS This study suggests that a change in clinical practice can significantly lower infection rates in patients undergoing DBS IPG replacement. These simple measures can minimize unnecessary surgery, loss of benefit from chronic stimulation, and costly hardware replacement, further improving the cost efficacy of DBS therapies.
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Joshua
J
Pepper
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Lara
L
Meliak
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Harith
H
Akram
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.|Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London.
Jonathan
J
Hyam
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Catherine
C
Milabo
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Joseph
J
Candelario
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Thomas
T
Foltynie
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.
Patricia
P
Limousin
Department of Clinical Microbiology, University College London Hospital, London, United Kingdom; and.
Carmel
C
Curtis
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.|Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.
Marwan
M
Hariz
Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square, London.|Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London.
Ludvic
L
Zrinzo
D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D046690:Deep Brain Stimulation / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058542:Implantable Neurostimulators; D017053:Infection Control / Q000379:methods; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin
DBS = deep brain stimulation; IPG = implantable pulse generator; MRSA = methicillin-resistant Staphylococcus aureus; Parkinson's disease; antibiotic; deep brain stimulation; functional neurosurgery; implantable pulse generator; infection; reoperation; vancomycin