- Incidence of infection
- Variable with rates of 3.2–27.5%
- Higher risk in
- Paeds
- Patient requiring ITB for management of severe spasticity compared
- Patient with increased risk for comorbidities such as microbial contamination from neurogenic bladder, decubitus ulcers, tracheotomies, and feeding tubes.
- Some evidence that the rates of infection are decreasing due to
- Use of a subfascial implant technique
- Improvements in presurgical prophylaxis
- Two types of infections:
- Superficial infection
- Eg: seromas and cellulitis
- Oral antibiotics (typically covering gram-positive bacteria) and without the need for explantation.
- Deeper, advancing infections.
- Broad spectrum IV antibiotics (such as cefazolin, clindamycin, or vancomycin)
- Explantation
- Pump rate should be titrated down more than 48–72 hours before explant to minimize the risk of ITB withdrawal while treating with antibiotics, unless the infection is life-threatening.
- Oral or IV antispasmodic supplementation should proceed as described in the underdosing section previously.
- The highest risk for infection typically occurs in the immediate perioperative phase.
- Consultation with infectious diseases specialists may be warranted to determine the scope and duration of antimicrobial therapy.
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