Bartek Jiri, Skyrman Simon, Nekludov Michael, Mathiesen Tiit, Lind Folke, Schechtmann Gaston
Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
Stereotact Funct Neurosurg. 2018;96(2):100-107. doi: 10.1159/000486684. Epub 2018 Apr 3.
In neuromodulation therapies, hardware-related infections are a major challenge often leading to hardware removal.
To investigate the role of adjuvant hyperbaric oxygen therapy (HBOT) in hardware-related infections.
Fourteen hardware-related infection events in 12 consecutive patients between 2002 and 2015 were treated with antibiotics and adjuvant HBOT at the Karolinska University Hospital (Stockholm, Sweden). Two time-independent infection events related to hardware replacements occurred in 2 patients. Infection resolution and the need for hardware removal were assessed.
Twelve out of 14 events of hardware-related infection were successfully treated without hardware removal (86%). The 2 patients treated twice with HBOT on 2 time-independent occasions could retain their hardware in both cases. Hardware was removed following HBOT failure in 2 infection events, with long-term infection control achieved in all patients. Further, an intrathecal pump malfunction caused by HBOT at 2.8 bars was observed, leading to a change in the manufacturer's guidelines.
This study indicates a potential benefit of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation, diminishing the need for hardware removal and treatment interruption. Prospective studies are warranted to establish the role of adjuvant HBOT in the treatment of hardware-related infections in neuromodulation.
在神经调节治疗中，与硬件相关的感染是一个重大挑战，常常导致硬件移除。
探讨辅助高压氧疗法（HBOT）在与硬件相关感染中的作用。
2002年至2015年间，卡罗林斯卡大学医院（瑞典斯德哥尔摩）对12例连续患者发生的14起与硬件相关的感染事件采用抗生素和辅助HBOT进行治疗。2例患者发生了2次与硬件更换相关的与时间无关的感染事件。评估感染消退情况及硬件移除的必要性。
14起与硬件相关的感染事件中有12起成功治疗，无需移除硬件（86%）。2例患者在2次与时间无关的情况下接受了2次HBOT治疗，在这两种情况下都保留了硬件。2例感染事件在HBOT治疗失败后移除了硬件，所有患者均实现了长期感染控制。此外，观察到在2.8巴压力下HBOT导致鞘内泵故障，促使制造商改变了指南。
本研究表明辅助HBOT在神经调节中治疗与硬件相关感染方面具有潜在益处，减少了硬件移除和治疗中断的需求。有必要进行前瞻性研究以确定辅助HBOT在神经调节中治疗与硬件相关感染的作用。
