Preventive effect of intraoperative antiseptic irrigation on surgical site infections after deep brain stimulation: a...

Deep brain stimulation (DBS) is an effective treatment for movement disorders. However, hardware-related infections following DBS surgery represent a serious complication, with incidence rates ranging from 2.6% to 10%. DBS hardware-related infections can lead to significant clinical deterioration, including loss of therapeutic stimulation benefits, recurrence of initial symptoms, potential hardware removal, and increased need for anti-infective therapy. Nevertheless, the key risk factors and potential preventive measures for these infections remain unclear. This study aims to evaluate the efficacy of intraoperative prophylactic irrigation with hydrogen peroxide, 0.5% povidone-iodine solution, and their combination in reducing the rate of hardware infections following DBS surgery.

A single-center retrospective cohort study was conducted, including patients who underwent DBS surgery between August 2016 and August 2024. Participants were categorized into one of four groups according to the intraoperative irrigation regimen used in clinical practice: saline, hydrogen peroxide, povidone-iodine, or combination. Only patients with complete operative and follow-up records were included. All patients were evaluated at four postoperative follow-up visits (1, 3, 6, and 12 months) to assess incision healing and surgical site infection (SSI) rates. Appropriate statistical analyses were employed to analyze variables of interest.

The overall surgical site infection (SSI) rate was 2.08% (8/385). The saline group exhibited a significantly higher infection rate compared to the intervention groups (4.2% vs. 1.03%, p = 0.039). The combination group did not demonstrate a synergistic effect (p > 0.05). Over approximately 8 years, 385 adult patients underwent 385 DBS procedures with bilateral electrode implantation, totaling 770 electrodes placed. Among these: Saline group: five SSI cases (5.26%) occurred within 1 year postoperatively. Pathogens identified: Staphylococcus aureus (n = 2) and Staphylococcus epidermidis (n = 3). Hydrogen peroxide group: 1 SSI case (1.02%) with Staphylococcus epidermidis identified. Povidone-iodine group: 1 SSI case (1.04%) with Staphylococcus aureus identified. Combination group: 1 SSI case with Enterobacter hormaechei identified.

Although, the characteristics of most patients evaluated in this study and operative duration were not associated with the risk of SSI, our data indicate that wound irrigation with hydrogen peroxide or 0.5% povidone-iodine solution may contribute to reduced SSI risk following DBS implantation.