TY - JOUR
T1 - Infected CNS infusion pumps. Is there a chance for treatment without removal?
AU - Boviatsis, Efstathios J.
AU - Kouyialis, A. T.
AU - Boutsikakis, I.
AU - Korfias, S.
AU - Sakas, D. E.
AU - Johnston, R. A.
AU - Bayston, Roger
PY - 2004/5
Y1 - 2004/5
N2 - Background. Intrathecal baclofen administration by means of an implantable pump is nowadays a safe and effective method in the treatment of spasticity. One of the rare but devastating complications of this technique is pump infection, with a variety of Gram (-) and Gram (+) organisms being involved. Treatment of these infections, according to international literature, requires removal of the device and appropriate antibiotic therapy. Method. This article reports the authors experience in treating 3 patients with severe, medically intractable spasticity, suffering from infection of the intrathecally-delivering pump. A decision was made not to replace the device, but to treat this complication with pump disinfection and with a new treatment modality that has never been used before, the intra-pocket administration of antibiotics. Findings. In all cases the infection was eradicated and the integrity of the pump maintained. None of the patients required a procedure under general anesthesia. Conclusions. Removal should no longer be considered the first treatment option in infections of intrathecally delivering pumps, especially those due to non-adherent bacteria, with mild clinical symptomatology. An initial attempt should always be made for conservative treatment. Intra-pocket administration of antibiotics helps in achieving high drugs levels locally, and may prove an important element in our armamentarium against such infections.
AB - Background. Intrathecal baclofen administration by means of an implantable pump is nowadays a safe and effective method in the treatment of spasticity. One of the rare but devastating complications of this technique is pump infection, with a variety of Gram (-) and Gram (+) organisms being involved. Treatment of these infections, according to international literature, requires removal of the device and appropriate antibiotic therapy. Method. This article reports the authors experience in treating 3 patients with severe, medically intractable spasticity, suffering from infection of the intrathecally-delivering pump. A decision was made not to replace the device, but to treat this complication with pump disinfection and with a new treatment modality that has never been used before, the intra-pocket administration of antibiotics. Findings. In all cases the infection was eradicated and the integrity of the pump maintained. None of the patients required a procedure under general anesthesia. Conclusions. Removal should no longer be considered the first treatment option in infections of intrathecally delivering pumps, especially those due to non-adherent bacteria, with mild clinical symptomatology. An initial attempt should always be made for conservative treatment. Intra-pocket administration of antibiotics helps in achieving high drugs levels locally, and may prove an important element in our armamentarium against such infections.
KW - Baclofen
KW - Infection
KW - Intrathecal infusion
KW - Pump
UR - http://www.scopus.com/inward/record.url?scp=2442469106&partnerID=8YFLogxK
U2 - 10.1007/s00701-004-0217-4
DO - 10.1007/s00701-004-0217-4
M3 - Article
C2 - 15118883
AN - SCOPUS:2442469106
SN - 0001-6268
VL - 146
SP - 463
EP - 467
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 5
ER -