Infections and Hardware Salvage after Deep Brain Stimulation Surgery: A Single-Center Study and Review of the Literature

Abstract

Aims: Infection of hardware is a serious complication after deep brain stimulation (DBS), as this may result in additional surgery, cost and loss of treatment benefit for the patient. We report the incidence and management of infections after DBS in a single institution over the past 11 years. Methods: A database of 270 patients with 484 implants was used in the study. Incidence, clinical characteristics and management of infections were analyzed. Results: The overall infection rate was 9.3% (25/270) by patients and 6.8% (33/484) by episode/implants. The median time of infection after implantation was 64 days. Only 7/33 episodes (21.2%) occurred within 30 days after surgery, 22/33 episodes (66.7%) within 6 months and 28/33 episodes (84.8%) within 12 months. There was no age difference between infected and noninfected patients, while comorbidities were more frequent in the former. Infection rates before and after January 2003 were 14.3 and 4.9%, respectively. The rate of complete and partial hardware salvage was 30.3 and 21.2% while that of complete hardware removal was 48.5%. Patients with deep purulent infections and patients with Staphylococcus aureus as the causative organism were more likely to have their hardware removed. Conclusions: The incidence of hardware infections declined significantly over time. Improvements in hardware and implantation techniques may be responsible. Hardware can often be completely or partly saved in infected patients.

The Factors Involved in Deep Brain Stimulation Infection: A Large Case Series

“…The rate of infection, especially the 2.01%, compares favorably across published studies. Still, it is difficult to compare percentages directly because different authors use a variety of criteria to define postsurgical DBS infection [7,8,9,10,11,12,13,14,15,16,17,18]. …”

“…Various authors have stated that older age [25] and younger age [17] can increase the risk as well as that it is not a factor at all [9,10,12,13,26]. Bhatia et al [10] identified several other factors, asserting that skin erosion, medical comorbidities, scalp thickness and burr hole cap thickness were all either risks for infection or higher in the infected patients in their retrospective review. Sixel-Doring et al [26] in turn found that age, gender, disease duration, disease severity, hypertension and diabetes were not statistically more likely to cause infection in their PD population.…”

“…Reported infection rates have varied considerably through the literature from 0.4 to 23%, likely secondary to differing surgical techniques, infection-preventative techniques, definitions of infection, infection computation (e.g. per surgery or per patient) and patient population [7,8,9,10,11,12,13,14,15,16,17,18]. The physical, economic and emotional repercussions of treating an infection and potential subsequent removal of the DBS hardware can be considerable [17].…”

Complications of Subthalamic Nucleus Stimulation in Parkinson's Disease

“…25) Device infection is one of the most probable device-related complications in DBS. 2,4,10,14,17,22,24) Since the DBS procedure involves the implantation of a foreign body, the risk of infection is high. Recent reported incidence of device infection varies from 0.4% to 10%.…”

Post-Operative Management of Parkinson Patients with Deep Brain Stimulation

“…They are exceptionally rare intracranially (Sillay et al, 2008). In most cases of a bacterial infection at the DBS system mere antibiotic treatment does not eradicate bacteria completely so that the system or part of the system needs to be explanted and replaced after a period of consolidation (Bhatia et al, 2010). Apart from infections, skin erosions can be a problem (Sixel-Döring et al, 2010).…”