In this post, I will continue my description of the third project I worked on in the lab: a study that explored the effectiveness of salvage procedures in neuromodulation. In my last post, I described some preventative measures taken to avoid infection in spinal cord stimulation (SCS), deep brain stimulation (DBS), and intrathecal (IT) pumps. Here, I will describe current treatment plans once infection has set in.
When a patient is suspected to have an infection, it must be determined if it is a superficial surgical site infection (SSI) or a deep SSI infection. Most superficial SSIs can be resolved with the use of antibiotic drugs, whereas deep SSI infections usually result in device removal. Partial removal of the device is not recommended as it is associated with relapse and treatment failure. Early diagnoses of infection increase the chances of device salvation. Infections can be diagnosed through clinical suspicion, laboratory testing, and proper diagnostic imaging. It can be difficult to distinguish between superficial infections versus deep infections. Positive cultures and imaging can be used to make a distinction. Infectious disease teams can assist in the treatment process.
Specifically for IT pump infection, the use of intravenous antibiotics for treatment is usually not recommended as therapeutic concentrations are hard to reach in the cerebrospinal fluid. However, one study found that the intrathecal coadministration of antibiotic agents (teicoplanin) and baclofen was able to completely resolve cases of infection. The study found that direct instillation of antibiotics into the reservoir enabled the antibiotic to target the infection, so the intrareservoir antibiotics were able to sterilize the interior of the pump.
Infections in DBS, SCS, and IT pumps can be life threatening. Although infection rates are relatively low in comparison to other complications, the risk of infection is still a serious concern. Treatment options are limited as device salvation or washout is usually unsuccessful. Antibiotic treatments are also unable to treat deep SSIs. Consequently, complete device removal is the most common solution.
In this retrospective study, we looked at 40 patients over an 8 year time period that underwent washout or partial salvage procedures. Washout procedures involve the irrigation and drainage of the infected area, while salvage procedures refer to the partial removal of the device in an attempt to salvage some of the device. Demographic variables, such as age, sex, body mass index (BMI), smoking status, anti-coagulation status, and device type were considered. The study's goal was to investigate why salvage procedures fail so often. Studying infection in neuromodulation and how it can be resolved is essential in reducing patient morbidity and expenses (due to complete device removal).
Research I have used to write this post: