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Changing of the guard: reducing infection when replacing neural pacemakers
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2017 (English)In: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 126, no 4, 1165-1172 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2017. Vol. 126, no 4, 1165-1172 p.
Keyword [en]
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
National Category
Neurosciences
Identifiers
URN: urn:nbn:se:umu:diva-134629DOI: 10.3171/2016.4.JNS152934ISI: 000397837900018PubMedID: 27315022OAI: oai:DiVA.org:umu-134629DiVA: diva2:1094486
Available from: 2017-05-10 Created: 2017-05-10 Last updated: 2017-05-15Bibliographically approved

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CiteExportLink to record
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Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
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  • fi-FI
  • nn-NO
  • nn-NB
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  • asciidoc
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