Methods: Patients 18 years or older with a DBS device placed at the Mayo Clinic in Rochester, Minnesota, between January 1, 2008 and December 31, 2014 with subsequent DBS infection were identified. The medical record was reviewed for demographic, microbiology, surgery, and outcomes.
Results: Thirty-three cases of DBS infection were identified. The most common indications for placement in DBS infection cases were tremor (41%) and Parkinson’s disease (38%). Thirty-one percent of patients had diabetes mellitus type 2. Mean age at diagnosis was 61.5 (±13.5) and 86% were males with mean BMI 28.1 (±6.4). The median time from DBS device placement to infection was 2 months [IQR 1,10]. The implantable pulse generator (IPG) was involved in 28/33 (85%) cases and the leads were involved in 25/33 (76%) cases. Only 18% of patients presented with fever, lead erosion occurred in 21% of cases, and purulent discharge from site of infection was noted in 61% of cases. Staphylococcus aureus was the most common (70%) organism, followed by coagulase negative staphylococci (12%). The median duration of antibiotic therapy was 14 days [14,26]. Complete removal of the infected DBS device occurred in 24/29 (73%). Sixty-one percent (20/33) underwent re-implantation of a new DBS device at a median time of 3 months [2,5] from device explantation. Of those who underwent re-implantation, 25% (5/20) relapsed with infection.
Conclusion: In a single center experience at the Mayo Clinic, DBS infections were predominantly caused by Staphylococcus aureus. Infections mostly involved the IPG, and presented approximately 2 months following DBS implantation. Blood cultures were negative in all cases. All patients who underwent complete device removal and treated with intravenous antibiotics (median time of 14 days) were cured. Twenty-five percent of patients who underwent reimplantation following a DBS infection relapsed.
A. J. Wright, None
K. Lee, None
P. Sampathkumar, Xenex Disinfection Services, LLC: Collaborator , Research support