Recommendations for the Prevention and Management of Deep Brain Stimulation Infections Based on 26-Year Single-Center Experience.

IF 1.9 4区医学 Q3 NEUROIMAGING

Stereotactic and Functional Neurosurgery Pub Date : 2024-01-01 Epub Date: 2024-06-21 DOI:10.1159/000539188

Johannes Kähkölä, Teija Puhto, Jani Katisko, Maija Lahtinen

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引用次数: 0

Abstract

Introduction: Infections related to deep brain stimulation (DBS) can lead to discontinuation of the treatment and increased morbidity. Various measures of reducing infection rates have been proposed in the literature, but scientific consensus is lacking. The aim of this study was to report a 26-year single center experience of DBS infections and provide recommendations for the prevention and management of them.

Methods: The retrospective analysis consisted of 978 DBS surgeries performed at Oulu University Hospital (OUH) from 1997 to 2022. This included 342 primary or reimplantations of DBS electrodes and 559 primary or reimplantations of implantable pulse generator (IPG). Infections within approximately 1 year after the surgery without secondary cause were considered surgical-site infections (SSIs). χ2 test was used to compare infection rates before and after 2013, when the systematic implementation of infection prevention measures was started.

Results: A total of 35 DBS implants were found to be infected. The number of SSIs was 30, of which 29 were originally operated in OUH leading to a center-specific infection rate of 3.1%. Of the SSIs, 17.2% occurred after IPG replacement. Staphylococcus aureus was found in 75.0% of cultures and 32.1% were mixed infections. The treatment of SSIs included aggressive surgical revision combined with cefuroxime and vancomycin antibiotics, as most patients in the initial conservative treatment group eventually required surgical revision. A statistically significant difference in infection rates before and after the implementation of preventative measures was not observed (risk ratio 2.20, 95% confidence interval 0.94-5.75, p = 0.051), despite over two-fold difference in the incidence of SSIs.

Conclusion: Our findings show that the rates of surgical infections are low in modern DBS, but due to their serious consequences, preventative measures should be implemented. We highlight that mixed infections should be accounted for in the antibiotic selection. Furthermore, our treatment recommendation includes aggressive surgical revision combined with antibiotic treatment.

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基于 26 年单中心经验的脑深部刺激感染预防和管理建议。

简介：与脑深部刺激（DBS）相关的感染可导致治疗中断和发病率增加。文献中提出了各种降低感染率的措施，但缺乏科学共识。本研究旨在报告一个单一中心 26 年来在 DBS 感染方面的经验，并提供预防和处理感染的建议：回顾性分析包括 1997 年至 2022 年期间在奥卢大学医院（OUH）进行的 978 例 DBS 手术。其中包括 342 例初次或再次植入 DBS 电极手术，559 例初次或再次植入植入式脉冲发生器 (IPG)。术后约 1 年内无继发原因的感染被视为手术部位感染（SSI）。在 2013 年开始系统实施感染预防措施之前和之后，感染率的比较采用χ2 检验：结果：共发现 35 个 DBS 植入物受到感染。SSI数量为30例，其中29例最初在OUH手术，中心感染率为3.1%。在 SSI 中，17.2% 发生在更换 IPG 之后。75.0%的培养物中发现了金黄色葡萄球菌，32.1%为混合感染。对 SSI 的治疗包括积极的手术翻修，同时使用头孢呋辛和万古霉素抗生素，因为最初保守治疗组的大多数患者最终都需要进行手术翻修。尽管 SSI 的发生率相差两倍多，但实施预防措施前后的感染率在统计学上没有发现明显差异（风险比 2.20，95% 置信区间 0.94-5.75，P = 0.051）：我们的研究结果表明，现代 DBS 的手术感染率较低，但由于其严重后果，应采取预防措施。我们强调，在选择抗生素时应考虑到混合感染。此外，我们的治疗建议包括积极的手术翻修和抗生素治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stereotactic and Functional Neurosurgery 医学-神经成像

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.