Deep Brain Stimulator Device Infection: The Mayo Clinic Rochester Experience

Hussam Tabaja; Jason Yuen; Don Bambino Geno Tai; Cristina Corsini Campioli; Supavit Chesdachai; Daniel C DeSimone; Anhar Hassan; Bryan T Klassen; Kai J Miller; Kendall H Lee; Maryam Mahmood

doi:10.1093/ofid/ofac631

Deep Brain Stimulator Device Infection: The Mayo Clinic Rochester Experience

Open Forum Infect Dis. 2022 Dec 26;10(1):ofac631. doi: 10.1093/ofid/ofac631. eCollection 2023 Jan.

Authors

Affiliations

¹ Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
³ Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
⁴ Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.

Abstract

Background: Deep brain stimulator (DBS)-related infection is a recognized complication that may significantly alter the course of DBS therapy. We describe the Mayo Clinic Rochester experience with DBS-related infections.

Methods: This was a retrospective study of all adults (≥18 years old) who underwent DBS-related procedures between 2000 and 2020 at the Mayo Clinic Rochester.

Results: There were 1087 patients who underwent 1896 procedures. Infection occurred in 57/1112 (5%) primary DBS implantations and 16/784 (2%) revision surgeries. The median time to infection (interquartile range) was 2.1 (0.9-6.9) months. The odds of infection were higher with longer operative length (P = .002), higher body mass index (BMI; P = .006), male sex (P = .041), and diabetes mellitus (P = .002). The association between infection and higher BMI (P = .002), male sex (P = .016), and diabetes mellitus (P = .003) remained significant in a subgroup analysis of primary implantations but not revision surgeries. Infection was superficial in 17 (23%) and deep in 56 (77%) cases. Commonly identified pathogens were Staphylococcus aureus (65%), coagulase-negative staphylococci (43%), and Cutibacterium acnes (45%). Three device management approaches were identified: 39 (53%) had complete device explantation, 20 (27%) had surgical intervention with device retention, and 14 (19%) had medical management alone. Treatment failure occurred in 16 (23%) patients. Time-to-event analysis showed fewer treatment failures with complete device explantation (P = .015). Only 1 individual had complications with brain abscess at failure.

Conclusions: Primary DBS implantations had higher rates of infection compared with revision surgeries. Complete device explantation was favored for deep infections. However, device salvage was commonly attempted and is a reasonable approach in select cases given the low rate of complications.

Keywords: DBS-related infection; deep brain stimulator; device-related infection; neuromodulation; neurosurgery infection.