Department of Neurosurgery, U.S. Department of Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Joseph J. Zilber School of Public Health, University of Wisconsin, Milwaukee, Wisconsin, USA.
World Neurosurg. 2019 Aug;128:e87-e97. doi: 10.1016/j.wneu.2019.04.003. Epub 2019 Apr 12.
Implant-related infections carry a high morbidity. Infectious rates for neuromodulation implants range from 1% to 9% for deep brain stimulation (DBS), 0% to 10% for spinal cord stimulation (SCS) systems, and 3% to 15% for intrathecal (IT) pump systems. Meanwhile, studies of care bundles report infection rate reduction to 1.0% for SCS and 0.3% for cardiac implants. Herein, we evaluate the effectiveness of an infection prevention bundle (IPB) in minimizing infections after surgeries for neuromodulation implants.
An IPB focused on preoperative checklists, screening questionnaires, methicillin-resistant and methicillin-sensitive Staphylococcus aureus decolonization, weight-based antibiotic prophylaxis, strict draping and surgical techniques, and wound care education was implemented in our functional neurosurgery division in April 2015. We retrospectively reviewed all surgeries for implantation or replacement of SCS, DBS, and IT pump system components from March 2013 to October 2017. The patients were divided into pre-IPB and post-IPB groups. All procedures were performed by a single surgeon. Each surgical site was considered a unique surgical case. Infection rates were calculated for pre-IPB and post-IPB groups.
A total of 688 patients underwent 1161 unique surgical procedures (222 DBS electrodes, 419 IPG, 203 SCS, 317 IT pumps) during the study period. There were 546 pre-IPB and 615 post-IPB surgical procedures. The pre-IPB infection rates were 0%, 1.3%, and 8.7% for SCS, DBS, and IT pumps, respectively. The post-IPB infection rates were 0%, 0.3%, and 1.8% for SCS, DBS, and IT pumps, respectively.
Implementation of a standardized IPB approach reduced the number of infections for all neuromodulation implants studied. This approach can be adopted within any specialty to potentially decrease the incidence of implant-related infections.
植入物相关感染的发病率很高。深部脑刺激（DBS）的神经调节植入物感染率为 1%至 9%，脊髓刺激（SCS）系统为 0%至 10%，鞘内（IT）泵系统为 3%至 15%。同时，护理包的研究报告显示，SCS 的感染率降低到 1.0%，心脏植入物的感染率降低到 0.3%。在此，我们评估感染预防包（IPB）在最大限度地减少神经调节植入物手术后感染的有效性。
2015 年 4 月，我们在功能神经外科部门实施了一项以术前清单、筛查问卷、耐甲氧西林和甲氧西林敏感金黄色葡萄球菌去定植、基于体重的抗生素预防、严格的覆盖和手术技术以及伤口护理教育为重点的 IPB。我们回顾性地审查了 2013 年 3 月至 2017 年 10 月期间所有植入或更换 SCS、DBS 和 IT 泵系统组件的手术。患者分为 IPB 前组和 IPB 后组。所有手术均由一名外科医生完成。每个手术部位被视为一个独特的手术病例。计算了 IPB 前组和 IPB 后组的感染率。
在研究期间，共有 688 名患者接受了 1161 次独特的手术（222 个 DBS 电极、419 个 IPG、203 个 SCS、317 个 IT 泵）。有 546 例 IPB 前手术和 615 例 IPB 后手术。SCS、DBS 和 IT 泵的 IPB 前感染率分别为 0%、1.3%和 8.7%。SCS、DBS 和 IT 泵的 IPB 后感染率分别为 0%、0.3%和 1.8%。
实施标准化的 IPB 方法降低了所有研究的神经调节植入物的感染数量。这种方法可以在任何专业中采用，以潜在地降低植入物相关感染的发生率。
