Department of Neurosurgery, Stanford University, Stanford, CA, USA.
Department of Neurosurgery, Stanford University, Stanford, CA, USA.
Neuromodulation. 2023 Feb;26(2):435-442. doi: 10.1016/j.neurom.2022.02.227. Epub 2022 Apr 11.
Deep brain stimulation (DBS) surgery is an established treatment for many patients with neurologic disease, and a common complication of DBS is surgical site infection (SSI). In 2016, neurosurgeons at our institution began enclosing implantable pulse generators (IPGs) within fully absorbable, antibacterial envelopes in patients who underwent initial DBS implantation. We sought to determine whether the use of antibacterial envelopes reduced IPG-related SSIs.
We performed a retrospective chart review of all adult patients who underwent initial DBS implantation at Stanford Hospital between November 14, 2012, and November 9, 2020. Operative details, perioperative antibiotics, comorbidities, and postoperative complications were extracted for all patients. Univariate and multivariate logistic regression were used to identify factors associated with SSIs within three months of surgery, and interrupted time-series analysis was performed to assess whether the departmental adoption of the antibacterial envelope led to a reduction in IPG SSIs.
Of 344 patients who underwent initial IPG implantation with the antibacterial envelope, one developed an SSI within three months of surgery (0.3%), compared with six of 204 patients (2.9%) who underwent the same procedure without the antibacterial envelope (odds ratio: 0.10, 95% CI: 0.01-0.80, p = 0.031). Univariate logistic regression revealed that the antibacterial envelope and 2000-mg intravenous cefazolin perioperatively were associated with reduced SSI risk, whereas no other factors reached statistical significance. After adjusting for comorbidities, no association remained statistically significant. Interrupted time-series analysis showed a reduction in SSIs after 2016, but the effect was not significant.
The adoption of antibacterial envelopes was found to reduce IPG SSIs at the univariate level, but this association did not remain significant after controlling for confounding variables including perioperative antibiotic administration. Although encouraging, this study does not conclusively establish that the use of antibacterial pouches in patients who underwent initial DBS implantation reduces the incidence of IPG SSIs. Future prospective studies that control for confounding variables are necessary to determine the efficacy of antibacterial envelopes in reducing post-DBS infections at the IPG site before clear recommendations can be made.
深部脑刺激（DBS）手术是治疗许多神经疾病患者的一种既定方法，DBS 的常见并发症是手术部位感染（SSI）。2016 年，我们机构的神经外科医生开始在接受初次 DBS 植入的患者中，将可植入脉冲发生器（IPG）包裹在完全可吸收的抗菌信封内。我们旨在确定使用抗菌信封是否可以减少 IPG 相关的 SSI。
我们对 2012 年 11 月 14 日至 2020 年 11 月 9 日期间在斯坦福医院接受初次 DBS 植入的所有成年患者进行了回顾性图表审查。提取所有患者的手术细节、围手术期抗生素、合并症和术后并发症。采用单变量和多变量逻辑回归来确定与术后三个月内 SSI 相关的因素，并进行中断时间序列分析，以评估部门采用抗菌信封是否会降低 IPG 的 SSI 发生率。
在 344 名接受抗菌信封包裹的初次 IPG 植入的患者中，有 1 例在术后三个月内发生 SSI（0.3%），而 204 名未使用抗菌信封的患者中有 6 例（2.9%）发生 SSI（比值比：0.10，95%CI：0.01-0.80，p=0.031）。单变量逻辑回归显示，抗菌信封和围手术期 2000mg 静脉头孢唑啉与降低 SSI 风险相关，而其他因素均无统计学意义。在调整合并症后，没有因素具有统计学意义。中断时间序列分析显示，2016 年后 SSI 减少，但效果不显著。
在单变量水平上，采用抗菌信封被发现可降低 IPG 的 SSI，但在控制包括围手术期抗生素使用在内的混杂变量后，这种关联不再具有统计学意义。虽然令人鼓舞，但这项研究并不能确定在接受初次 DBS 植入的患者中使用抗菌套囊可降低 IPG SSI 的发生率。在可以提出明确建议之前，需要进行未来的前瞻性研究，以控制混杂变量，确定抗菌套囊在降低 DBS 后 IPG 部位感染方面的效果。
