Stim with chronic hardware infection on suppressive abx?

[Timeoutofmind]

Guy with a lumbar hardware infection after fusion several years ago just presented to me this week. They did not feel they could safely take the hardware out so he is on chronic bactrim for suppression for staph epi all these years.

No clinical signs of infection at this point obviously.

Would be a good stim candidate otherwise. He was asking about it.

I was thinking basically no way. My thought process was that the hardware that is infected is outside of the epidural space, so I could theoretically introduce an infection into the epidural space if there is just some kind of micro-seeding in the blood or any of the other tissues my needle goes through.

Would anyone consider? I could send to ID for clearance but dont want to bother if it is just a bad idea all around.

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[willabeast]

//Would anyone consider?// No. And if admin forced me somehow i would quit first.

 

[Orin]

It's a risk/benefit question for you and your surgical backup.

If you take any implants away, is the patient treatable with an acceptable medical regimen?

This is all elective, but I'm sure someone out there would do it if the patient looks hard enough. It sounds like an academic center case.

If you are 6 - 12 months out, you could check markers of infection/inflammation, talk to ID, give him a trial off antibiotics, check blood cultures, and then stay as far away as you could from the lumbar surgical site for the trial. Staph epi is generally something you can cure I thought.

 

[lobelsteve]

You can do it. I would not. Ever.

 

[244913]

Too risky for me

 

[deleted185747]

I saw a similar case at the VA. Pt with infected knee hardware on chronic suppressive abx and asymptomatic needed SCS. Sent to ID who said that as long as the suppressive abx are working he's not going to seed the SCS implant. Eventually suppressive abx fail due to resistance of the bacteria then pt will have a full blown infection and become bacteremic and require a new abx. Hopefully by then his SCS implant is well encapsulated and not going to be seeded by a bacteremia in the future.

Your case sounds similar except that the hardware is closer to where you will be working and if your incision breaches the infected area then your implant will become immediately seeded and infected.

I would do if the infected hardware was far away from the planned surgical site, pocket and tunnel.

 

[Pain_doc]

I'd pass.