Infections associated with intrathecal baclofen therapy: a multicentre case-control study

Intrathecal baclofen (ITB) is used to manage spasticity in neurologically disabled patients. Infections related to ITB pumps are serious complications. This study assessed the incidence, risk factors, treatment, and outcomes of ITB-related infections in adults.

We conducted a retrospective case-control study in three referral centres in Paris, including all patients with ITB between 2017 and 2024. Infections were defined by clinical signs, significant positive microbiological findings and antibiotic use.

Among 302 patients who received ITB, 19 (6.3%) developed infections. Infected patients were younger (median age: 43 vs 49 years), were mostly male (84.2%) and more often had spinal cord injury (68.4% vs 35.0%, P = 0.007) or alcohol use (26.3% vs 6.7%, P = 0.009). Infections occurred early (<1 month) in 42.1%, between 1 and 12 months in 26.3%, and late (>1 year) in 31.6%. Local inflammatory signs were common; Staphylococcus spp. were predominant, followed by Gram-negative bacilli. Prior surgery for infection was significantly associated with ITB-related infection [odds ratio: 10.43; 95% confidence interval: (2.50-43.00)]. Alcohol use and spinal cord injury were also independent risk factors. All infected patients underwent pump explantation and antibiotic therapy (median: 14.5 days), with favourable outcomes.

ITB pump infections are rare in our experience but significantly associated with spinal cord injury, alcohol use and prior infectious surgery. Early identification and appropriate management yield favourable outcomes. These findings support targeted preventive strategies and reinforce the importance of surgical technique and postoperative vigilance.