RESEARCH: Treating infected Baclofen pumps

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Infected CNS infusion pumps. Is there a chance for

treatment without removal?

Boviatsis EJ, Kouyialis AT, Boutsikakis I, Korfias S,

Sakas DE.

Department of Neurosurgery, University of Athens

Medical School, Evangelismos General Hospital, Athens,

Greece.

Background. Intrathecal baclofen administration by

means of an implantable pump is nowadays a safe and

effective method in the treatment of spasticity. One

of the rare but devastating complications of this

technique is pump infection, with a variety of Gram

(-) and Gram (+) organisms being involved. Treatment

of these infections, according to international

literature, requires removal of the device and

appropriate antibiotic therapy. Method. This article

reports the authors experience in treating 3 patients

with severe, medically intractable spasticity,

suffering from infection of the

intrathecally-delivering pump. A decision was made not

to replace the device, but to treat this complication

with pump disinfection and with a new treatment

modality that has never been used before, the

intra-pocket administration of antibiotics. Findings.

In all cases the infection was eradicated and the

integrity of the pump maintained. None of the patients

required a procedure under general anesthesia.

Conclusions. Removal should no longer be considered

the first treatment option in infections of

intrathecally delivering pumps, especially those due

to non-adherent bacteria, with mild clinical

symptomatology. An initial attempt should always be

made for conservative treatment. Intra-pocket

administration of antibiotics helps in achieving high

drugs levels locally, and may prove an important

element in our armamentarium against such infections.

SOURCE: Acta Neurochir (Wien). 2004 May;146(5):463-7.

Epub 2004 Mar 22.

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