Multidisciplinary Pain Management Department, Department of Anesthesia, Valencia University General Hospital, Valencia, Spain.
Multidisciplinary Pain Management Department, Department of Anesthesia, Valencia University General Hospital, Valencia, Spain; Infectious Diseases Unit, Valencia University Medical School, Valencia, Spain.
Pain Physician. 2018 May;21(3):E235-E246.
Chronic back pain is a prevalent disease and has a high impact in daily life. Implantable devices (IDs) for chronic pain management include spinal cord stimulation (SCS) systems and intrathecal drug delivery (ITDD) pumps. The number of ITDD implants have increased exponentially in the last decade. The number of complications, such as infections, are also more prevalent. Infection management guidelines are needed to standarize our clinical practice and define protocols of explantation.
The primary outcome is to define the likelihood of device explantation regarding some covariates related to the patient, antibiotic therapy or surgerical procedures. The secondary outcome is to evaluate performance compared to the results published in the literature.
Retrospective study.
Hospital General of Valencia. Valencia. Spain.
A retrospective study of 288 implantable device surgeries was conducted at the Hospital General Universitary of Valencia (Spain) from 1994 to 2015. Demographical and infection data were collected. We have followed the "guidelines for the diagnosis, prevention and management of implantable electronic cardiac device infection" due to the lack of a specific guideline in our field.
Forty-three out of 288 procedures were identified as suspected device-infected interventions. Half of the patients had microbiologically confirmed infection after wound, blood or lumbar fluid culture. The odds ratio (OR) for explantation of the device was 19 for the presence of decubitus, a sign of medical device related pressure injury (P < 0.0005) and 5 for positive wound culture (P < 0.0452). Medical indication leading to device implantation and the antibiotics on discharge also played a role in the decision of device explantation.
Lack of external validity and others.
In this study, presence of decubitus is the defining variable for device explantation when a infection is suspected rather than waiting to culture results. Due to a high variability in infection rates, multidisciplinary guidelines are needed to provide an approach that focuses on accurate data monitoring, rigurous implantation technique and standardized protocols.
Chronic pain, spinal cord stimulation infection, neurostimulator, intrathecal drug delivery pump, complication, infection, explantation.
慢性背痛是一种常见疾病，对日常生活有很大影响。用于慢性疼痛管理的植入式设备包括脊髓刺激（SCS）系统和鞘内药物输送（ITDD）泵。在过去十年中，ITDD 植入物的数量呈指数级增长。感染等并发症也更为普遍。需要感染管理指南来规范我们的临床实践并定义取出（设备）的方案。
主要结果是确定与患者、抗生素治疗或手术程序相关的一些协变量与设备取出的可能性。次要结果是评估与文献中公布的结果相比的性能。
回顾性研究。
西班牙巴伦西亚综合医院。
对 1994 年至 2015 年在西班牙巴伦西亚综合大学医院进行的 288 例植入式设备手术进行了回顾性研究。收集了人口统计学和感染数据。由于我们领域缺乏特定指南，因此我们遵循了“植入式电子心脏设备感染的诊断、预防和管理指南”。
在 288 例手术中，有 43 例被确定为疑似设备感染的干预措施。一半的患者在伤口、血液或腰椎液培养后微生物学证实感染。存在褥疮（医疗器械相关压力性损伤的迹象）的设备取出的优势比（OR）为 19（P < 0.0005），伤口培养阳性的 OR 为 5（P < 0.0452）。导致设备植入的医学指征和出院时的抗生素也在设备取出的决策中发挥了作用。
缺乏外部有效性等。
在这项研究中，当怀疑感染时，存在褥疮是决定设备取出的决定性变量，而不是等待培养结果。由于感染率的高度变化，需要多学科指南来提供一种方法，重点是准确的数据监测、严格的植入技术和标准化的方案。
慢性疼痛、脊髓刺激感染、神经刺激器、鞘内药物输送泵、并发症、感染、取出。
