Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application

Clinical article

Jonathan P. Miller, Feridun Acar, Kim Burchiel

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Object. Hardware infection is a common occurrence after the implantation of neurostimulation and intrathecal drug delivery devices. The authors investigated whether the application of a neomycin/polymyxin solution directly into the surgical wound decreases the incidence of perioperative infection. Methods. Data from all stereotactic and functional hardware procedures performed at the Oregon Health & Science University over a 5-year period were reviewed. All patients received systemic antibiotic prophylaxis. For the last 18 months of the 5-year period, wounds were additionally injected with a solution consisting of 40 mg neomycin and 200,000 U polymyxin B sulfate diluted in 10 ml normal saline. The primary outcome measure was infection of the hardware requiring explantation. Results. Six hundred fourteen patients underwent hardware implantation. Among 455 patients receiving only intravenous antibiotics, the infection rate was 5.7%. Only 2 (1.2%) of 159 patients receiving both intravenous and local antibiotics had an infection. The wounds in both of these patients were compromised postoperatively: 1 patient had entered a swimming pool, and the other had undergone a general surgery procedure that exposed the hardware. If these patients are excluded from analysis, the effective infection rate using a combined intravenous and local antibiotic prophylaxis is 0%. There were no complications due to toxicity. Conclusions. The combination of local neomycin/polymyxin with systemic antibiotic therapy can lead to a significantly lower rate of postoperative infection than when systemic antibiotics are used alone.

Original languageEnglish (US)
Pages (from-to)247-250
Number of pages4
JournalJournal of Neurosurgery
Volume110
Issue number2
DOIs
StatePublished - Feb 2009

Fingerprint

Polymyxins
Neomycin
Infection
Anti-Bacterial Agents
Antibiotic Prophylaxis
Swimming Pools
Polymyxin B
Wounds and Injuries
Outcome Assessment (Health Care)
Equipment and Supplies
Incidence
Health

Keywords

  • Hardware infection
  • Local antibiotic
  • Neomycin

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application : Clinical article. / Miller, Jonathan P.; Acar, Feridun; Burchiel, Kim.

In: Journal of Neurosurgery, Vol. 110, No. 2, 02.2009, p. 247-250.

Research output: Contribution to journalArticle

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