The incidence of deep brain stimulator hardware infection: the effect of change in antibiotic prophylaxis regimen and review of the literature
The incidence of deep brain stimulator hardware infection: the effect of change in antibiotic prophylaxis regimen and review of the literature
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DOI：
10.3109/02688697.2011.566384
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发表时间：
2011-10-01
影响因子：
1.1
通讯作者：
Nandi, Dipankar
中科院分区：
文献类型：
--
作者：
Bhatia, Robin;Dalton, Arthur;Nandi, Dipankar
在文献中，与脑深部刺激器植入（或翻修）相关的硬件感染并发症在0 - 15.2%之间。然而，目前还没有国家指南来定义与该手术相关的平均感染率或可接受感染率，也没有规定该手术所需的首选抗生素预防。本研究的目的是研究改变单一神经外科中心使用的抗生素预防方案对硬体感染的发生率和结局的影响。将38例接受深部脑刺激（DBS）植入或内脉冲产生器（IPG）置换并接受围手术期万古霉素（包括诱导时静脉注射庆大霉素）和袋装庆大霉素的患者与35例在同一单位接受围手术期头孢呋辛的患者进行前瞻性队列比较。前瞻性DBS手术组2年感染率为0，而历史队列为1 (5.6%)(p = 0.11, chi(2))；在前瞻性队列中，IPG替代品的感染率为1(3.6%)，而在历史队列中为3 (17.6%)（p = 0.44, chi(2)）。在这篇文章中，我们也系统地回顾了迄今为止的文献，得出35项研究中3550名患者的平均感染率为4.7% （PI为0.9-22%，随机效应荟萃分析，Stata）。与有一段时间电极外化的DBS手术（n = 23）相比，主要内化的DBS手术（n = 9）的感染率没有显著差异（p = 0.9， meta回归分析，Stata）。
The complication of hardware infection related to deep brain stimulator implantation (or revision) varies between 0 and 15.2% in the literature. However, no national guidelines exist at present to define an average or acceptable rate of infection associated with, nor the preferred antibiotic prophylaxis required for, this procedure. The aim of this study was to examine the effect of changing the antibiotic prophylaxis regimen used in a single neurosurgical centre on the incidence and outcome of hardware infection. A prospective cohort of 38 patients undergoing deep brain stimulation (DBS) implantation or internal pulse generator (IPG) replacement and receiving perioperative vancomycin (including intravenous gentamicin on induction) and pouch-installed gentamicin, was compared to a historical cohort of 35 patients receiving perioperative cefuroxime in the same unit. The infection rate over 2 years in the prospective group for DBS surgery was 0 compared to 1 (5.6%) in the historical cohort (p = 0.11, chi(2)); the infection rate for IPG replacements was 1(3.6%) in the prospective cohort, versus 3 (17.6%) in the historical (p = 0.44, chi(2)). In this article, we have also systematically reviewed the literature to date and derived an average infection rate of 4.7% (PI 0.9-22%, Random Effects Meta-analysis, Stata) for 35 studies comprising 3550 patients. There is no significant difference in infection rates between DBS procedures that are primarily internalised (n = 9) compared to those in which there is a period of electrode externalisation (n = 23) (p = 0.9, Meta-regression analysis, Stata).