Deep Brain Stimulator Device Infection: The Mayo Clinic Rochester Experience

Author:

Tabaja Hussam1ORCID,Yuen Jason2,Tai Don Bambino Geno1,Campioli Cristina Corsini1,Chesdachai Supavit1,DeSimone Daniel C13,Hassan Anhar4,Klassen Bryan T4,Miller Kai J2,Lee Kendall H2,Mahmood Maryam1ORCID

Affiliation:

1. Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic , Rochester, Minnesota , USA

2. Department of Neurologic Surgery, Mayo Clinic , Rochester, Minnesota , USA

3. Department of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota , USA

4. Department of Neurology, Mayo Clinic , Rochester, Minnesota , USA

Abstract

Abstract Background Deep brain stimulator (DBS)–related infection is a recognized complication that may significantly alter the course of DBS therapy. We describe the Mayo Clinic Rochester experience with DBS-related infections. Methods This was a retrospective study of all adults (≥18 years old) who underwent DBS-related procedures between 2000 and 2020 at the Mayo Clinic Rochester. Results There were 1087 patients who underwent 1896 procedures. Infection occurred in 57/1112 (5%) primary DBS implantations and 16/784 (2%) revision surgeries. The median time to infection (interquartile range) was 2.1 (0.9–6.9) months. The odds of infection were higher with longer operative length (P = .002), higher body mass index (BMI; P = .006), male sex (P = .041), and diabetes mellitus (P = .002). The association between infection and higher BMI (P = .002), male sex (P = .016), and diabetes mellitus (P = .003) remained significant in a subgroup analysis of primary implantations but not revision surgeries. Infection was superficial in 17 (23%) and deep in 56 (77%) cases. Commonly identified pathogens were Staphylococcus aureus (65%), coagulase-negative staphylococci (43%), and Cutibacterium acnes (45%). Three device management approaches were identified: 39 (53%) had complete device explantation, 20 (27%) had surgical intervention with device retention, and 14 (19%) had medical management alone. Treatment failure occurred in 16 (23%) patients. Time-to-event analysis showed fewer treatment failures with complete device explantation (P = .015). Only 1 individual had complications with brain abscess at failure. Conclusions Primary DBS implantations had higher rates of infection compared with revision surgeries. Complete device explantation was favored for deep infections. However, device salvage was commonly attempted and is a reasonable approach in select cases given the low rate of complications.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Oncology

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