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An antibiotic envelope to reduce infections in deep brain stimulation surgery

Published:November 19, 2022DOI:https://doi.org/10.1016/j.jocn.2022.10.031

      Highlights

      • Surgical site infections in neurosurgery can result in significant morbidity.
      • Retrospective review conducted of all Deep Brain Stimulation surgeries.
      • An antibiotic envelope can prevent the onset of surgical site infections.
      • An antibiotic envelope is therefore a safe and well-tolerated adjunct.
      • No implant removal was required.

      Abstract

      The therapeutic benefits of Deep Brain Stimulation (DBS) surgery in patients with movement disorders such as Parkinson’s Disease are life-altering. Surgical site infections (SSI), however, can result in increased hospitalisations, prolonged antibiotics and neurological sequelae. We performed a retrospective review to evaluate the effectiveness of an antibiotic envelope to reduce SSI in DBS surgeries. This study included all DBS surgeries performed between August 2020 to May 2022 using a single-use, multifilament, antibiotic-coated mesh envelope wrapped around the DBS implantable pulse generator (IPG) (TYRX™ Absorbable Antibacterial Envelope, Medtronic Fridley, MN, USA). Standardised infection-prevention measures were applied and various patient-specific and surgery-specific factors were analysed. 44 patients were analysed with 26 (59.1 %) primary implantations and 18 (40.9 %) revision surgeries. The median age was 65 years old with an average follow-up of 13.5 months (range 3–24 months). The mean Body Mass Index was 24.0 (range 16.7–35.6). 8 (18.2 %) patients had underlying diabetes mellitus. There were only 2 (4.5 %) SSIs reported with neither involving the subcutaneous IPG and antibiotic envelope. 1 superficial-incisional SSI (2.3 %) was from a prior retro-auricular abscess around a lead-wire requiring antibiotics and subcutaneous implant transposition. The other was a deep-incisional SSI (2.3 %) from repetitive trauma causing delayed scalp wound dehiscence and lead-wire extrusion, requiring antibiotics and wound revision. Both subjects were discharged well with no implants removed. The antibiotic envelope therefore appears to be a safe and well-tolerated adjunct that may reduce SSIs in DBS surgery. Further prospective work with larger sample sizes in a multi-institution setting is required.

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