Surgical Neuromodulation: Prevalence of Staphylococcus Aureus, Decolonization and Rates of Infection

Introduction: Methicillin resistant S. aureus (MRSA) and Methicillin susceptible S. aureus (MSSA) are known to colonize various bodily locations and present unique challenges in the prevention and treatment of deep surgical site infections (SSIs). Our goal was to determine if preoperative colonization testing and decolonization protocols reduce the rate of SSIs in patients undergoing surgical neuromodulation procedures.

Methods: Using a prospectively maintained database, a single surgeon, single facility, retrospective study identified 503 spinal cord stimulation (SCS), 1,000 deep brain stimulation (DBS) and 449 intrathecal baclofen (ITB) pump procedures performed on 385 unique SCS, 426 DBS, and 326 ITB pumps patients, between June of 2013 and May of 2024. Pre-operative S. aureus nasal swab results, post-operative deep SSIs requiring device removal and patient-related comorbidities were analyzed. Different peri-operative colonization screening, decolonization and antibiotic protocols were assessed.

Results: Approximately 20% of all SCS/DBS and 30% of ITB patients were positive for S. aureus. MSSA colonization was six times more common than MRSA colonization in SCS/DBS patients and three times more common for ITB patients. MRSA colonization was three times more common in ITB patients compared to SCS/DBS patients. There were no SSI in SCS patients. ITB patients had a decrease in infection rate from 8% down to less than 2% upon implementation of pre-operative decolonization protocols. Other findings include no significant difference in infection rate comparing initial implant and implant replacement and that previous SSI, urinary catheter, or infection within 30 days is associated with increased infection rate.

Conclusion : This study represents the most comprehensive report to date analyzing the prevalence of pre-operative MRSA and MSSA colonization in patients undergoing a wide array of surgical neuromodulation procedures. Our data support the recommendation that patients receiving neuroimplantables be: 1) screened for both MRSA and MSSA, as screening for MRSA alone misses a large fraction of S. aureus colonization; 2) considered for decolonization protocols prior to surgery. Following these recommendations may eliminate SSIs in SCS patients and help reduce SSIs in DBS and ITB pump patients.