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Published on: October 2, 2015
The Risk of Bacterial Colonization Increases With Multiple Replacements of Implanted Pulse Generators for Deep Brain
David Wasilewski1, Ada Marie Hoffmann2, Franziska Braun3
1Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Department of Neurosurgery, Charité- University Medicine Berlin, Berlin, Germany.
Repeated deep brain stimulation (DBS) implanted pulse generator (IPG) replacements increase microbial colonization, particularly with low-virulence bacteria. Sonication improves pathogen detection, but careful interpretation is needed to distinguish colonization from infection.
Area of Science:
- Neurosurgery
- Infectious Disease
- Microbiology
Background:
- Deep brain stimulation (DBS) improves movement disorder treatment.
- Repeated implanted pulse generator (IPG) replacements are necessary but risk surgical site infections.
- Understanding microbial colonization changes during IPG replacements is crucial.
Purpose of the Study:
- To investigate microbial colonization dynamics during consecutive IPG replacements.
- To compare pathogen detection rates between sonication and standard culture methods.
- To analyze temporal changes in microbial profiles after IPG replacement.
Main Methods:
- Retrospective observational study of patients with two consecutive IPG replacements.
- Intraoperative tissue cultures and explanted IPG sonication for microbial detection.
- Categorization of identified microorganisms and statistical comparison of detection methods.
Main Results:
- Pathogen detection significantly increased at the second IPG replacement (29 vs 15 pathogens, p=0.04).
- Coagulase-negative staphylococci (CNS) and Cutibacterium acnes were predominant; high-virulence pathogens were rare.
- Sonication showed a higher detection rate than standard cultures, especially for CNS and C. acnes (p=0.08).
Conclusions:
- Repeated IPG replacements alter the microbial environment, increasing colonization with low-virulence organisms.
- Sonication enhances pathogen detection but requires careful interpretation to differentiate colonization from infection.
- Optimized diagnostic strategies are needed for patients undergoing multiple DBS hardware replacements.
