期刊
ACTA NEUROCHIRURGICA
卷 146, 期 5, 页码 463-467出版社
SPRINGER WIEN
DOI: 10.1007/s00701-004-0217-4
关键词
intrathecal infusion; pump; baclofen; infection
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.
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