MP30-03 A NOVEL SACRAL NEUROMODULATION INFECTION PROTOCOL IS ASSOCIATED WITH REDUCTION IN DEVICE INFECTION

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-03 A NOVEL SACRAL NEUROMODULATION INFECTION PROTOCOL IS ASSOCIATED WITH REDUCTION IN DEVICE INFECTION Hayden Hill*, Thomas Dukovac, Amy Long, James Conner, and Colin Goudelocke Hayden Hill*Hayden Hill* More articles by this author , Thomas DukovacThomas Dukovac More articles by this author , Amy LongAmy Long More articles by this author , James ConnerJames Conner More articles by this author , and Colin GoudelockeColin Goudelocke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacral Neuromodulation (SNM) device infection is an expensive and distressing complication that may occur in up to 10% of implants. There are a multitude of possible risk factors for infection including antibiotic selection, skin preparation, as well as duration and modality of pre-implantation testing. We sought to develop an infection protocol in order to minimize the risk of device infection, decrease the use of toxic antibiotic agents, eliminate post-procedure antibiotic prophylaxis, and mitigate the additional risk of staged testing. Analysis of all prior infections in our database demonstrated infection with S. aureus and thus our protocol included screening and treatment of patients for S. aureus colonization of the nares. METHODS: Data were collected prospectively from January 2014 to September 2019 and pre-protocol comparison data from October 2011 to December 2013 were analyzed retrospectively as controls. All patients undergoing SNM procedures underwent nasal swab to screen for S. aureus. Patients with positive nasal cultures were treated with 7 days of intranasal mupirocin and MRSA-positive individuals underwent preoperative prophylaxis with Vancomycin. Patients with negative screening cultures were treated preoperatively with cefazolin unless allergic. Patients undergoing staged-lead testing were evaluated at one week for possible implantation. Any device explant associated with signs or symptoms of infection was recorded as a device infection. No post-procedure prophylaxis was used. RESULTS: A total of 108 SNM procedures in 80 pre-protocol patients and 634 procedures in 383 protocol patients were included. Infection rates were significantly reduced in the protocol group with respect to total procedures (4/108, 3.7% vs 3/634, 0.47%, p=0.0013) and total patients (4/80, 5.0% vs 3/383, 0.78%, p=.0049). Within the protocol group, 84.2% (322/382) of patients were negative for S. aureus, 11.2% (43/382) were MRSA positive, and 4.4% (17/382) were MSSA positive. Patients undergoing full implant after a staged test rather than after successful percutaneous nerve evaluation increased significantly in the protocol group (61.5%, 48/78 vs 99.1%, 241/243, p<.0001). Average duration of staged-lead testing decreased from a mean of 9.7 days (95% CI [8.6-10.8]) to 8.0 days (95% CI [7.6-8.4]). CONCLUSIONS: Instituting an SNM device infection protocol was associated with a significant reduction in rates of infection. Infection rates decreased despite increased rates of staged-lead testing and elimination of post procedure antibiotic prophylaxis. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e438-e439 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hayden Hill* More articles by this author Thomas Dukovac More articles by this author Amy Long More articles by this author James Conner More articles by this author Colin Goudelocke More articles by this author Expand All Advertisement PDF downloadLoading ...