Infection.

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Abstract

18. Expert Rev Anti Infect Ther. 2017 Mar;15(3):241-255. doi: 10.1080/14787210.2017.1267563. Epub 2016 Dec 13. Management of infections associated with neurosurgical implanted devices. Conen A(1), Fux CA(1), Vajkoczy P(2), Trampuz A(3). Author information: (1)a Clinic of Infectious Diseases and Hospital Hygiene , Department of Internal Medicine, Kantonsspital Aarau , Aarau , Switzerland. (2)b Department of Neurosurgery , Charité - Universitätsmedizin Berlin , Berlin , Germany. (3)c Center for Musculoskeletal Surgery , Charité - Universitätsmedizin Berlin , Berlin , Germany. Neurosurgical devices are increasingly used. With it, neurosurgical device-related infections gain relevance. As biofilms are involved in implant-associated infections the diagnosis and treatment is challenging and requires specific anti-biofilm concepts and management algorithms. Areas covered: The literature concerning the management of neurosurgical device-associated infections is scarce and heterogeneous treatment concepts are discussed, but no standardized diagnostic and treatment procedures exist. Therefore, we emphasize extrapolating management strategies predominantly from orthopedic device-associated infections, where the concept is better established and clinically validated. This review covers infections associated with craniotomy fixation devices, cranioplasties, external ventricular and lumbar drainages, internal shunts and neurostimulators. Expert commentary: Sonication of the removed implants significantly improves microbiological diagnosis. A combined surgical and antimicrobial management is crucial for successful treatment: appropriate surgical intervention is combined with prolonged anti-biofilm therapy of usually 12 weeks. In selected patients, new treatment algorithms enable cure of neurosurgical device-associated infections without implant removal or with a one-stage implant exchange, considerably improving the quality of patient lives. DOI: 10.1080/14787210.2017.1267563