SUFU 2018: A Novel Sacral Neuromodulation Infection Protocol is Associated with Reduction in Device Infection

Austin, TX ( Dr. Colin Murrah Goudelocke and colleagues  presented a prospective study of 468 sacral neuromodulation procedures performed on 288 patients, from 2014 to 2017.  The authors designed an infection protocol in order to try and decrease SNM device infections, mainly due to staphylococcus aureus colonization. 108 procedures on 80 patients were performed prior to protocol implementation and 360 procedures on 208 patients were performed after the protocol.

All patients undergoing SNM implant or revision who were in the protocol had a nasal swab to detect for S. aureus.  If screening patients were positive, the authors treated them with 5 days of intranasal mupirocin.  If patients tested positive for MRSA, they were given preoperative Vancomycin.   If negative, patients were treated with cefazolin, unless contraindicated by allergy.  All patients were given a prep of chlorhexidine scrub and isopropyl alcohol/iodine povacrylex paint.  Patients undergoing staged-lead testing were then re-evaluated at one week postop.

The authors found the infection rates in the protocol group were decreased, when compared to total procedures (4/108, 3.7% vs 1/360, 0.3%, p=0.0028) and total patients (4/80, 5.0% vs 1/208, 0.5%, p=.0092).  Within the protocol group, 87.4% of nasal swabs were negative for S. aureus, 8.2% were positive for MRSA, and 4.4% were MSSA-positive. Vancomycin was used as preoperatively in 10.6% of patients. No patient in the protocol group with MRSA-positive nares developed a SNM device infection. 

The authors were able to show that this new infection protocol decreased the rates of infection related to SNM procedures, and importantly, decreasing the use of Vancomycin as well. 

Presented by: Colin Murrah Goudelocke, MD, Department of Urology, University of Tennessee - Erlanger, Chattanooga, Tennessee

Co-Authors: James Connor BA, BS, Lincoln Memorial University − DeBusk College of Osteopathic Medicine, Harrogate, TN and  Amy Long MSN, Erlanger Health System; ³Department of Urology, University of Tennessee - Erlanger, Chattanooga, Tennessee

Written by: Cristina Palmer, DO. Female Urology, Pelvic Reconstruction, Voiding Dysfunction Fellow, Department of Urology, UC Irvine Medical Center, Orange, California at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting (SUFU 2018), February 27-March 3, 2018, Austin, Texas