Intrathecal drug delivery system infections (meningitis, encephalitis, pump pocket contaminants)

Abstract

Intrathecal drug delivery system (IDDS) infections are one of the most feared complications associated with intrathecal drug therapy. It can range from an infection of the pocket containing the implanted intrathecal pump to a more clinically concerning meningitis or encephalitis. Risk factors include neutropenia, diabetes mellitus, smoking, and poor nutrition. Diagnosis of an infection is based on a detailed history and physical examination as well as an elevated white blood cell (WBC) count, elevated C-reactive protein (CRP), and confirmation of the microorganism in the pocket fluid or cerebrospinal fluid (CSF). Brain MRI may be beneficial in identifying meningitis, and ultrasound is beneficial in identifying fluid in the pump pocket or thoracic incision. Treatment varies from a course of oral antibiotics to intravenous antibiotics and explant of the IDDS.