Objectives
Intrathecal baclofen (ITB) pumps are an effective treatment for spasticity; however
infection rates have been reported in 3–26% of patients in the literature. The multidisciplinary
ITB service has been established at The National Hospital for Neurology and Neurosurgery,
UCLH, Queen Square, London for over 20 years. Our study was designed to clarify the
rate of infection in our ITB patient cohort and secondly, to formulate and implement
best practice guidelines and to determine prospectively, whether they effectively
reduced infection rates.
Methods
Clinical record review of all patients receiving ITB pre-intervention; January 2013–May
2015, and following practice changes; June 2016–June 2018.
Results
Four of 118 patients receiving ITB during the first time period (3.4%, annual incidence
rate of infection 1.4%) developed an ITB-related infection (three following ITB pump
replacement surgery, one after initial implant). Infections were associated with 4.2%
of ITB-related surgical procedures. Three of four pumps required explantation.
Following change in practice (pre-operative chlorhexidine skin wash and intraoperative
vancomycin wash of the fibrous pocket of the replacement site), only one of 160 ITB
patients developed infection (pump not explanted) in the second time period (0.6%,
annual incidence rate 0.3%). The infection rate related to ITB surgical procedures
was 1.1%. In cases of ITB pump replacement, the infection rate was reduced to 3.3%
from 17.6%.
Conclusions
This study suggests that a straightforward change in clinical practice may lower infection
rates in patients undergoing ITB therapy.
Keywords:
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COMMENT
Article info
Publication history
Accepted:
September 10,
2019
Received in revised form:
July 24,
2019
Received:
March 5,
2019
Footnotes
For more information on author guidelines, an explanation of our peer review process, and conflict of interest informed consent policies, please go to http://www.wiley.com/WileyCDA/Section/id-301854.html
Source(s) of financial support: None.
Identification
Copyright
© 2020 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
