Intrathecal Baclofen Pump Infection With Meningitis: Effective Treatment by Radical Debridement and Intrareservoir Baclofen-Vancomycin Co-Infusion.

Autor: Koljonen PA; Division Department of Orthopaedics & Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong., Chan SHS; Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong., Liu T; Division Department of Orthopaedics & Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong., Ho ACC; Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong., Chim S; Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong., Tsoi NS; Department of Paediatrics & Adolescent Medicine, University of Hong Kong, Hong Kong., Wong YW; Division Department of Orthopaedics & Traumatology, Queen Mary Hospital, University of Hong Kong, Hong Kong.
Jazyk: angličtina
Zdroj: Neuromodulation : journal of the International Neuromodulation Society [Neuromodulation] 2021 Oct; Vol. 24 (7), pp. 1223-1228. Date of Electronic Publication: 2021 Feb 03.
DOI: 10.1111/ner.13369
Abstrakt: Objectives: Intrathecal baclofen pump associated central nervous system (CNS) infection and meningitis is a rare but serious complication and may have dire consequences. Due to bacterial biofilm formation, the optimal treatment strategy is usually for removal of the pump, followed by systemic antibiotics for treatment of local and CNS infection. We describe this case of a patient with recurrent Staphylococcus aureus pump site empyema and meningitis leading to status dystonicus, who was successfully managed with radical debridement and intrareservoir baclofen-vancomycin co-infusion.
Materials and Methods: We retrospectively report a case of infected intrathecal baclofen pump with meningitis and provide a full review of literature.
Conclusions: To the best of our knowledge, this is the first reported case of intrathecal baclofen (ITB)-associated pump site empyema and meningitis successfully treated with this technique. In selected cases where surgical explantation is deemed not feasible, this method can provide clinicians with an additional option for pump salvage and retention, while eradicating CNS infection and maintaining optimal control of spasticity and dystonia.
(© 2021 International Neuromodulation Society.)
Databáze: MEDLINE
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