Evaluation of salvage techniques for infected baclofen pumps in pediatric patients with cerebral palsy

Clinical article

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Object

Intrathecal baclofen therapy has been used successfully for intractable spasticity in children with cerebral palsy. Infections are rare, but they are potentially life threatening if complicated by bacteremia or meningitis. Treatment without removal of the system is desirable if it can be done safely and effectively.

Methods

The authors reviewed the records of 207 patients ranging from 3 to 18 years of age with cerebral palsy who underwent placement or revision of a baclofen pump. They identified 38 patients with suspected or documented infectious complications. Initial attempts were made to eradicate infection with the devices in situ in all patients. Methods and effectiveness of pump salvage were evaluated.

Results

Of the 38 patients identified, 13 (34.2%) had documented infections; 11 had deep wound/pocket empyemas and 2 had meningitis. Eight patients with deep wound infections received intravenous antibiotics alone. All required pump explantation. The remaining 3 patients underwent a washout procedure as well; the infection was cured in 1 patient. Both patients with meningitis received intravenous and intrathecal antibiotics, and both required device explantation. In addition, 25 patients (65.8%) had excessive or increasing wound erythema. No objective criteria to document a superficial infection were present. The wounds were considered suspicious and were managed with serial examinations and oral antibiotics. The erythema resolved in 24 of the 25 patients.

Conclusions

In general, observation, wound care, and oral antibiotics are sufficient for wounds that are suspicious for superficial infection. For deep-seated infection, antibiotic therapy alone is generally insufficient and explantation is required. Washout procedures can be considered, but failures are common.

Abbreviation used in this paper:ITB = intrathecal baclofen.
Article Information

Contributor Notes

Address correspondence to: John R. Vender, M.D., Department of Neurosurgery, Medical College of Georgia, BI 3088, 1120 15th Street, Augusta, Georgia 30912-2900. email: jvender@georgiahealth.edu.Please include this information when citing this paper: published online October 5, 2012; DOI: 10.3171/2012.9.PEDS12121.

© AANS, except where prohibited by US copyright law.

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