Risk factors for baclofen pump infection in children: a multivariate analysis

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.</jats:p></jats:sec>

Identification of complications in paediatric cerebral palsy treated with intrathecal baclofen pump: A descriptive analysis of 15 years at one institution

“…In the study, there was a positive relationship between CSF leak and early infection. 28 Similarly, 19 patients had early infection and eight patients had CSF complaints, and there was a positive correlation between the risk of early infection and CSF leak in our study. We believe that early CSF leak diagnosis and treatment might reduce the risk of secondary infection and need for multiple secondary ITB procedures leading to further complications.…”

“…In 85 (24.9%) of our cases, 90 CSF leak episodes were documented which is higher than previously published rates. 14,28 A study by Taira et al 29 reported the ratio of patients with CSF leak was 3.3% and another study gave a CSF leak rate of 3.9%. 28 Vender and colleagues 19 declared that the rate of CSF leak and pseudomeningocele requiring reoperation in children with ITB was 12%.…”

“…14,28 A study by Taira et al 29 reported the ratio of patients with CSF leak was 3.3% and another study gave a CSF leak rate of 3.9%. 28 Vender and colleagues 19 declared that the rate of CSF leak and pseudomeningocele requiring reoperation in children with ITB was 12%. We attributed the high rate found in our study to the inclusion of not only those who were treated but also patients with spontaneous resolution.…”

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

“…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 .…”

Laparoscopic fundoplication for a child with abdominal intrathecal Baclofen pump

“…Secondly, all efforts should be made to prevent postoperative infection while performing abdominal procedures in a child with an ITB pump in-situ, as any infection may lead to a critical complication like meningitis. Previous studies on ITB pump complications in children report a relatively high incidence of infection at ≤10% [1][2][3] . Some investigators have tried to reduce the rate of occurrence of ITB pump-related infections through perioperative care of the implantation site 4 .…”