Infectious Complications of Intrathecal Drug Administration Systems for Spasticity and Chronic Pain: 145 Patients From a Tertiary Care Center

Malheiro, Luís; Gomes, A.; Barbosa, Patrícia; Santos, Lurdes; Sarmento, António

doi:10.1111/ner.12265

Cited by 35 publications

(20 citation statements)

References 26 publications

(26 reference statements)

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“…The neurologic patient population may be at an increased risk for comorbidities such as microbial contamination from neurogenic bladder, decubitus ulcers, tracheotomies, and feeding tubes. There is some evidence that the rates of infection are decreasing, perhaps due to the use of a subfascial implant technique and improvements in presurgical prophylaxis .…”

Section: Treatment Of Underdosing/withdrawalmentioning

confidence: 99%

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Saulino

Anderson

Doble

et al. 2016

Neuromodulation: Technology at the Neural Interface

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Section: Treatment Of Underdosing/withdrawalmentioning

confidence: 99%

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Saulino

Anderson

Doble

et al. 2016

Neuromodulation: Technology at the Neural Interface

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“…The most common presentations were fever and drainage from the surgical site. Other series have reported similar rates of infection [54]. As in patients who have CSF shunts, symptoms can be divided into those indicative of local wound infection (eg, erythema, swelling, and purulent drainage at surgical sites) and those indicative of meningitis.…”

Section: Evidence Summarymentioning

confidence: 99%

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Tunkel

Hasbun

Bhimraj

et al. 2017

Clinical Infectious Diseases

659

671

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The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.

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“…21 Type of infection, pathogenic agent and established treatment were already described by Malheiro et al regarding complications that occurred until May 2014. 24 Antibiotic prophylaxis with 2 g of intravenous cefazolin is recommended by national and institutional guidelines for surgical site infection prevention and may explain our results. 25 Problems related to the catheter occurred in 9.6% of cases (24/251).…”

Section: Discussionmentioning

confidence: 65%

Intrathecal Baclofen Infusion Pumps in the Treatment of Spasticity: A Retrospective Cohort Study in a Portuguese Centre

Reis¹,

Vieira²,

Midões³

et al. 2019

Acta Med Port

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Introduction: Spasticity is a complex problem in patients with neurological disorders and may distress their quality of life. Intrathecal baclofen infusion pumps reduce spasticity with low doses and minimal side effects but are not free from complications. We aimed to evaluate the efficacy and safety of intrathecal baclofen infusion pumps as well as patients' satisfaction. Material and Methods: Retrospective cohort study including all intrathecal baclofen infusion pumps placed up to December 2015. Demographic characteristics, clinical diagnoses, date of placement or withdrawal/replacement of intrathecal baclofen infusion pumps, baclofen dosage and complications of intrathecal baclofen infusion pumps were collected. Assessments from the Ashworth and Penn's scales, Katz index and patients' global satisfaction were analysed. Results: In 19 years we placed 251 intrathecal baclofen infusion pumps in 155 patients. The mean age was 41.1 ± 15.8 years. The most frequent conditions were: trauma (34%), cerebral palsy (14%), multiple sclerosis (12%) and stroke (12%). Eighty-five patients (55%) required a second pump, and eleven (7%) a third one. The lifetime of the first pump was 72 (36 -89) and the total follow-up time was 96 (9 -132) months. The causes of withdrawal/replacement were: battery failure (57%), catheter migration/kinking (24%), infection (14%) and pump displacement/exteriorization (7%). The complication rate was 0.21 events/month. There was a significant improvement in the Ashworth and Penn's scales after the placemen of intrathecal baclofen infusion pumps (p < 0.001 for all diagnoses) and the patients were satisfied with the treatment. Discussion: The incidence of complications was within range of other international studies despite our long follow-up time. Events per month, loss to follow-up, re-intervention rate, incidence of infection and mortality were similar to other studies. Conclusion: Intrathecal baclofen infusion pumps are safe and effective in the treatment of spasticity. Infusion pumps provide a high level of satisfaction regarding treatment and quality of life.Intrathecal baclofen dose (μg/day) -median (P25 -P75) 230 (95 -400)

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Infectious Complications of Intrathecal Drug Administration Systems for Spasticity and Chronic Pain: 145 Patients From a Tertiary Care Center

Cited by 35 publications

References 26 publications

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

Intrathecal Baclofen Infusion Pumps in the Treatment of Spasticity: A Retrospective Cohort Study in a Portuguese Centre

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