{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:25:00Z","timestamp":1794219900255,"version":"4.8.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>\n                      Methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA) and methicillin-susceptible\n                      <jats:italic>S. aureus<\/jats:italic>\n                      (MSSA) are known to colonize various bodily locations and present unique challenges in the prevention and treatment of deep surgical site infections (SSIs). The aim of this study was to determine if preoperative colonization testing and decolonization protocols reduce the rate of SSIs in patients undergoing surgical neuromodulation procedures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      Using a prospectively maintained database, a single-surgeon, single-facility, retrospective study identified 513 spinal cord stimulation (SCS) procedures, 1050 deep brain stimulation (DBS) procedures, and 414 intrathecal baclofen (ITB) pump procedures performed between June 2013 and June 2024. These procedures were performed in 361 patients receiving SCS devices, 375 patients receiving DBS devices, and 308 patients receiving ITB pumps. Preoperative\n                      <jats:italic>S. aureus<\/jats:italic>\n                      nasal swab results, postoperative superficial and deep SSIs requiring device removal, and patient-related comorbidities were analyzed. Patients were monitored for at least 6 months postoperatively for deep SSIs. Different perioperative colonization screening, decolonization, and antibiotic protocols were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Approximately 20% of all patients undergoing implantation of SCS\/DBS devices and 25% of patients undergoing implantation of ITB devices had positive results for\n                      <jats:italic>S. aureus<\/jats:italic>\n                      . MSSA colonization was 14 times more common than MRSA colonization in patients who underwent SCS procedures, 9 times more common in those who underwent DBS procedures, and 3 times more common in those who underwent ITB pump procedures. MRSA colonization was 3 times more common in patients who underwent ITB pump procedures than in those who underwent SCS\/DBS procedures. There were no deep SSIs in the SCS group. Patients in the ITB pump group had a decrease in infection rate from 8% down to &lt; 2% after implementation of preoperative decolonization protocols.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\n                      This study represents the most comprehensive report to date analyzing the prevalence of preoperative MRSA and MSSA colonization in patients undergoing a wide array of surgical neuromodulation procedures. These data support the recommendation that patients receiving neuroimplantable devices, specifically patients undergoing ITB pump procedures, be 1) screened for both MRSA and MSSA, as screening for MRSA alone will not reveal a large fraction of\n                      <jats:italic>S. aureus<\/jats:italic>\n                      colonization; and 2) considered for decolonization protocols prior to surgery. Following these procedures significantly reduced SSIs in patients who underwent ITB pump implantation procedures and might have reduced SSIs for SCS and DBS implantation procedures as well.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.11.jns241759","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T13:13:01Z","timestamp":1773925981000},"page":"302-310","source":"Crossref","is-referenced-by-count":0,"title":["Surgical neuromodulation: prevalence of Staphylococcus aureus, decolonization, and rates of infection"],"prefix":"10.3171","volume":"145","author":[{"given":"Randall W.","family":"Treffy","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pranjal","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Palmer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A.","family":"Pahapill","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"24","key":"b1","series-title":"N Engl J Med","first-page":"1871","article-title":"Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections","volume":"346","author":"Perl TM","year":"2002","unstructured":"Perl TM, Cullen JJ, Wenzel RP,  Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med. 2002;346(24):1871\u20131877. doi:10.1056\/NEJMoa003069"},{"issue":"6","key":"b2","series-title":"Neuromodulation","first-page":"553","article-title":"Spinal cord stimulator related infections: findings from a multicenter retrospective analysis of 2737 implants","volume":"20","author":"Bendel MA","year":"2017","unstructured":"Bendel MA, O\u2019Brien T, Hoelzer BC,  Spinal cord stimulator related infections: findings from a multicenter retrospective analysis of 2737 implants. Neuromodulation. 2017;20(6):553\u2013557. doi:10.1111\/ner.12636"},{"issue":"6","key":"b3","series-title":"Neuromodulation","first-page":"558","article-title":"Spinal cord stimulator implant infection rates and risk factors: a multicenter retrospective study","volume":"20","author":"Hoelzer BC","year":"2017","unstructured":"Hoelzer BC, Bendel MA, Deer TR,  Spinal cord stimulator implant infection rates and risk factors: a multicenter retrospective study. Neuromodulation. 2017;20(6):558\u2013562. doi:10.1111\/ner.12609"},{"key":"b4","series-title":"Front Hum Neurosci","first-page":"708481","article-title":"Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity","volume":"15","author":"Sarica C","year":"2021","unstructured":"Sarica C, Iorio-Morin C, Aguirre-Padilla DH,  Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity. Front Hum Neurosci. 2021;15:708481. doi:10.3389\/fnhum.2021.708481"},{"issue":"8","key":"b5","series-title":"PLoS One","first-page":"e105288","article-title":"Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period","volume":"9","author":"Bjerknes S","year":"2014","unstructured":"Bjerknes S, Skogseid IM, S\u00e6hle T, Dietrichs E, Toft M. Surgical site infections after deep brain stimulation surgery: frequency, characteristics and management in a 10-year period. PLoS One. 2014;9(8):e105288. doi:10.1371\/journal.pone.0105288"},{"issue":"6","key":"b6","series-title":"Anesthesiology","first-page":"1582","article-title":"Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections","volume":"100","author":"Follett KA","year":"2004","unstructured":"Follett KA, Boortz-Marx RL, Drake JM,  Prevention and management of intrathecal drug delivery and spinal cord stimulation system infections. Anesthesiology. 2004;100(6):1582\u20131594. doi:10.1097\/00000542-200406000-00034"},{"issue":"7","key":"b7","series-title":"Pediatr Infect Dis J","first-page":"715","article-title":"Infectious complications of intrathecal baclofen pump devices in a pediatric population","volume":"32","author":"Dickey MP","year":"2013","unstructured":"Dickey MP, Rice M, Kinnett DG,  Infectious complications of intrathecal baclofen pump devices in a pediatric population. Pediatr Infect Dis J. 2013;32(7):715\u2013722. doi:10.1097\/INF.0b013e318287f02a"},{"issue":"4","key":"b8","series-title":"Microbiol Spectr","article-title":"Staphylococcal biofilms","volume":"6","author":"Otto M","year":"2018","unstructured":"Otto M. Staphylococcal biofilms. Microbiol Spectr. 2018;6(4):10.1128\/microbiolspec.gpp3. doi:10.1128\/microbiolspec.GPP3-0023-2018"},{"issue":"17","key":"b9","series-title":"J Bone Joint Surg Am","first-page":"1449","article-title":"The current state of screening and decolonization for the prevention of Staphylococcus aureus surgical site infection after total hip and knee arthroplasty","volume":"97","author":"Weiser MC","year":"2015","unstructured":"Weiser MC, Moucha CS. The current state of screening and decolonization for the prevention of Staphylococcus aureus surgical site infection after total hip and knee arthroplasty. J Bone Joint Surg Am. 2015;97(17):1449\u20131458. doi:10.2106\/JBJS.N.01114"},{"issue":"2","key":"b10","series-title":"J Arthroplasty","first-page":"752","article-title":"Is preoperative Staphylococcus aureus screening and decolonization effective at reducing surgical site infection in patients undergoing orthopedic surgery? A systematic review and meta-analysis with a special focus on elective total joint arthroplasty","volume":"36","author":"Ribau AI","year":"2021","unstructured":"Ribau AI, Collins JE, Chen AF, Sousa RJ. Is preoperative Staphylococcus aureus screening and decolonization effective at reducing surgical site infection in patients undergoing orthopedic surgery? A systematic review and meta-analysis with a special focus on elective total joint arthroplasty. J Arthroplasty. 2021;36(2):752\u2013766.e6. doi:10.1016\/j.arth.2020.08.014"},{"issue":"5","key":"b11","series-title":"Neuromodulation","first-page":"1089","article-title":"Prevalence of Staphylococcus aureus colonization in spinal cord stimulator surgical procedures","volume":"26","author":"Provenzano DA","year":"2023","unstructured":"Provenzano DA, Keith AD, Kilgore JS. Prevalence of Staphylococcus aureus colonization in spinal cord stimulator surgical procedures. Neuromodulation. 2023;26(5):1089\u20131094. doi:10.1016\/j.neurom.2022.04.048"},{"key":"b12","series-title":"World Neurosurg","first-page":"e87","article-title":"Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience","volume":"128","author":"Arocho-Quinones EV","year":"2019","unstructured":"Arocho-Quinones EV, Huang CC, Ward BD, Pahapill PA. Care bundle approach to minimizing infection rates after neurosurgical implants for neuromodulation: a single-surgeon experience. World Neurosurg. 2019;128:e87\u2013e97. doi:10.1016\/j.wneu.2019.04.003"},{"issue":"1","key":"b13","series-title":"Neuromodulation","first-page":"15","article-title":"The Neurostimulation Appropriateness Consensus Committee (NACC) safety guidelines for the reduction of severe neurological injury","volume":"20","author":"Deer TR","year":"2017","unstructured":"Deer TR, Lamer TJ, Pope JE,  The Neurostimulation Appropriateness Consensus Committee (NACC) safety guidelines for the reduction of severe neurological injury. Neuromodulation. 2017;20(1):15\u201330. doi:10.1111\/ner.12564"},{"issue":"5","key":"b14","series-title":"Neuromodulation","first-page":"928","article-title":"Staphylococcus aureus swabbing and decolonization before neuromodulation procedures: a systematic review and meta-analysis","volume":"26","author":"Patel N","year":"2023","unstructured":"Patel N, Gold J, Brown NJ,  Staphylococcus aureus swabbing and decolonization before neuromodulation procedures: a systematic review and meta-analysis. Neuromodulation. 2023;26(5):928\u2013937. doi:10.1016\/j.neurom.2022.07.013"},{"issue":"2","key":"b15","series-title":"Neuromodulation","first-page":"179","article-title":"Spinal cord stimulation infection rate and risk factors: results from a United States payer database","volume":"22","author":"Falowski SM","year":"2019","unstructured":"Falowski SM, Provenzano DA, Xia Y, Doth AH. Spinal cord stimulation infection rate and risk factors: results from a United States payer database. Neuromodulation. 2019;22(2):179\u2013189. doi:10.1111\/ner.12843"},{"issue":"3","key":"b16","series-title":"Microbiol Mol Biol Rev","first-page":"e00026","article-title":"Staphylococcal biofilm development: structure, regulation, and treatment strategies","volume":"84","author":"Schilcher K","year":"2020","unstructured":"Schilcher K, Horswill AR. Staphylococcal biofilm development: structure, regulation, and treatment strategies. Microbiol Mol Biol Rev. 2020;84(3):e00026\u2013e00019. doi:10.1128\/MMBR.00026-19"},{"issue":"5","key":"b17","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373\u2013383. doi:10.1016\/0021-9681(87)90171-8"},{"issue":"5","key":"b18","series-title":"Neuromodulation","first-page":"367","article-title":"Incidence of revision surgery in a large cohort of patients with thoracic surgical three-column paddle leads: a retrospective case review","volume":"18","author":"Pahapill PA","year":"2015","unstructured":"Pahapill PA. Incidence of revision surgery in a large cohort of patients with thoracic surgical three-column paddle leads: a retrospective case review. Neuromodulation. 2015;18(5):367\u2013375. doi:10.1111\/ner.12239"},{"issue":"6","key":"b19","series-title":"Neuromodulation","first-page":"1090","article-title":"Spinal cord stimulation trial electrodes rapidly produce epidural scarring, impeding surgical paddle lead placement","volume":"27","author":"Treffy RW","year":"2024","unstructured":"Treffy RW, Morris J, Koshy R, Coss DJ, Pahapill PA. Spinal cord stimulation trial electrodes rapidly produce epidural scarring, impeding surgical paddle lead placement. Neuromodulation. 2024;27(6):1090\u20131097. doi:10.1016\/j.neurom.2024.01.004"},{"issue":"10","key":"b20","series-title":"Eur Spine J","first-page":"2457","article-title":"Impact of MSSA screening on rates of surgical site infection following lumbar spine surgery","volume":"27","author":"Higgins M","year":"2018","unstructured":"Higgins M, Bommireddy R, Shivji F, Al-Shukri J, Billson J. Impact of MSSA screening on rates of surgical site infection following lumbar spine surgery. Eur Spine J. 2018;27(10):2457\u20132462. doi:10.1007\/s00586-018-5705-y"},{"key":"b21","series-title":"World Neurosurg","first-page":"205","article-title":"Neurosurgical infection rates and risk factors: a National Surgical Quality Improvement Program analysis of 132,000 patients, 2006-2014","volume":"97","author":"Karhade AV","year":"2017","unstructured":"Karhade AV, Cote DJ, Larsen AM, Smith TR. Neurosurgical infection rates and risk factors: a National Surgical Quality Improvement Program analysis of 132,000 patients, 2006-2014. World Neurosurg. 2017;97:205\u2013212. doi:10.1016\/j.wneu.2016.09.056"},{"key":"b22","series-title":"World Neurosurg","first-page":"551","article-title":"Operative duration and risk of surgical site infection in neurosurgery","volume":"94","author":"Bekelis K","year":"2016","unstructured":"Bekelis K, Coy S, Simmons N. Operative duration and risk of surgical site infection in neurosurgery. World Neurosurg. 2016;94:551\u2013555.e6. doi:10.1016\/j.wneu.2016.07.077"},{"issue":"2","key":"b23","series-title":"Neuromodulation","first-page":"197","article-title":"Deep brain stimulation-related surgical site infections: a systematic review and meta-analysis","volume":"24","author":"Kantzanou M","year":"2021","unstructured":"Kantzanou M, Korfias S, Panourias I, Sakas DE, Karalexi MA. Deep brain stimulation-related surgical site infections: a systematic review and meta-analysis. Neuromodulation. 2021;24(2):197\u2013211. doi:10.1111\/ner.13354"},{"issue":"1","key":"b24","series-title":"Stereotact Funct Neurosurg","first-page":"56","article-title":"The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure","volume":"91","author":"Pepper J","year":"2013","unstructured":"Pepper J, Zrinzo L, Mirza B, Foltynie T, Limousin P, Hariz M. The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure. Stereotact Funct Neurosurg. 2013;91(1):56\u201365. doi:10.1159\/000343202"},{"issue":"2","key":"b25","series-title":"J Hosp Infect","first-page":"144","article-title":"Staphylococcus aureus screening and decolonization reduces the risk of surgical site infections in patients undergoing deep brain stimulation surgery","volume":"95","author":"Lefebvre J","year":"2017","unstructured":"Lefebvre J, Buffet-Bataillon S, Henaux PL, Riffaud L, Morandi X, Haegelen C. Staphylococcus aureus screening and decolonization reduces the risk of surgical site infections in patients undergoing deep brain stimulation surgery. J Hosp Infect. 2017;95(2):144\u2013147. doi:10.1016\/j.jhin.2016.11.019"},{"issue":"4","key":"b26","series-title":"J Neurosurg","first-page":"1165","article-title":"Changing of the guard: reducing infection when replacing neural pacemakers","volume":"126","author":"Pepper J","year":"2017","unstructured":"Pepper J, Meliak L, Akram H,  Changing of the guard: reducing infection when replacing neural pacemakers. J Neurosurg. 2017;126(4):1165\u20131172. doi:10.3171\/2016.4.JNS152934"},{"issue":"7","key":"b27","series-title":"Neuromodulation","first-page":"991","article-title":"Reducing intrathecal baclofen related infections: service evaluation and best practice guidelines","volume":"23","author":"Balaratnam MS","year":"2020","unstructured":"Balaratnam MS, Donnelly A, Padilla H,  Reducing intrathecal baclofen related infections: service evaluation and best practice guidelines. Neuromodulation. 2020;23(7):991\u2013995. doi:10.1111\/ner.13071"},{"issue":"1 Suppl","key":"b28","series-title":"J Neurosurg","first-page":"9","article-title":"Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients","volume":"104","author":"Vender JR","year":"2006","unstructured":"Vender JR, Hester S, Waller JL, Rekito A, Lee MR. Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg. 2006;104(1 Suppl):9-15. doi:10.3171\/ped.2006.104.1.9"},{"issue":"3","key":"b29","series-title":"J Neurosurg Pediatr","first-page":"301","article-title":"Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience","volume":"13","author":"Motta F","year":"2014","unstructured":"Motta F, Antonello CE. Analysis of complications in 430 consecutive pediatric patients treated with intrathecal baclofen therapy: 14-year experience. J Neurosurg Pediatr. 2014;13(3):301\u2013306. doi:10.3171\/2013.11.PEDS13253"},{"issue":"1","key":"b30","series-title":"Psychother Psychosom","first-page":"8","article-title":"Charlson Comorbidity Index: a critical review of clinimetric properties","volume":"91","author":"Charlson ME","year":"2022","unstructured":"Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8\u201335. doi:10.1159\/000521288"},{"key":"b31","series-title":"World Neurosurg","first-page":"e989","article-title":"Using a data-driven improvement methodology to decrease surgical site infections in a community neurosurgery practice: optimizing preoperative screening and perioperative antibiotics","volume":"149","author":"Kerezoudis P","year":"2021","unstructured":"Kerezoudis P, Kelley PC, Watts CR, Heiderscheit CJ, Roskos MC. Using a data-driven improvement methodology to decrease surgical site infections in a community neurosurgery practice: optimizing preoperative screening and perioperative antibiotics. World Neurosurg. 2021;149:e989\u2013e1000. doi:10.1016\/j.wneu.2021.01.060"},{"issue":"10","key":"b32","series-title":"Int Urogynecol J","first-page":"2421","article-title":"A novel sacral neuromodulation protocol is associated with reduction in removal for device infection","volume":"34","author":"Goudelocke C","year":"2023","unstructured":"Goudelocke C, Hill H, Major N, Couvaras A, Long A. A novel sacral neuromodulation protocol is associated with reduction in removal for device infection. Int Urogynecol J. 2023;34(10):2421\u20132428. doi:10.1007\/s00192-023-05543-z"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p302.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p302.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p302.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T09:56:01Z","timestamp":1794218161000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p302.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":32,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2025.11.jns241759","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}