Differences in sacral neuromodulation device infection rates based on preoperative antibiotic selection

Area of Science:

• Urology
• Infectious Disease
• Surgical Outcomes

Background:

• Wound infection is a significant complication following sacral neuromodulation (SNM) implantation, often necessitating device removal.
• Previous reports indicate infection rates between 5-11%, but specific risk factors remain underexplored.

Purpose of the Study:

• To determine the postoperative wound infection rate after SNM implantation.
• To identify potential predictive factors for wound infections, hypothesizing a link to perioperative antibiotic selection.

Main Methods:

• A retrospective review of 136 patients who underwent SNM implantation between 2007 and 2010.
• Analysis of preoperative antibiotic regimens (cefazolin, vancomycin, or vancomycin with gentamicin) and other potential risk factors using multivariate techniques.

Main Results:

• A total of 8 infections (5.9%) required device explantation.
• Preoperative cefazolin monotherapy was significantly less effective (p=0.03) than other regimens, with a 7.3-fold increased odds of infection.
• Staphylococcus aureus resistant to cephalosporins was identified in seven of the eight explanted devices.

Conclusions:

• Preoperative antibiotic choice is a significant factor in preventing infections and device explantation after SNM placement.
• Optimizing antibiotic selection may reduce complication rates and improve patient outcomes.