J Neurosurg 145:302–310, 2026
Infection of an implanted neuromodulation system may require complete hardware removal and interruption of an effective therapy. This study examines nasal *Staphylococcus aureus* colonization and infection-prevention protocols across almost 2,000 procedures involving deep brain stimulation, spinal cord stimulation and intrathecal baclofen pumps. Methicillin-susceptible strains were substantially more frequent than MRSA and would be missed by MRSA-only screening. Introducing decolonization was associated with a marked reduction in infection after baclofen-pump procedures. The findings support screening both MSSA and MRSA before implantation while recognizing the limitations of a retrospective before-and-after comparison.
Objective
To determine the prevalence of preoperative MRSA and MSSA colonization in patients undergoing surgical neuromodulation and assess whether screening and decolonization protocols were associated with fewer surgical-site infections.
Methods
Using a prospectively maintained database, the authors retrospectively analyzed procedures performed by one surgeon at one institution between June 2013 and June 2024. The series comprised 513 spinal cord stimulator procedures, 1,050 deep brain stimulator procedures and 414 intrathecal baclofen-pump procedures.
Preoperative nasal swab results, superficial infections, deep infections requiring device removal, comorbidities and successive perioperative screening, decolonization and antibiotic protocols were reviewed. Patients were observed for at least 6 months for deep infection.
#### Main results
Approximately 20% of patients receiving spinal cord or deep brain stimulation and 25% receiving an intrathecal baclofen pump were colonized with *S. aureus*. MSSA was 14 times more frequent than MRSA in the spinal cord stimulation group, 9 times more frequent in the deep brain stimulation group and 3 times more frequent in the baclofen-pump group.
No deep surgical-site infections occurred in the spinal cord stimulation group. After implementation of preoperative decolonization, the infection rate associated with intrathecal baclofen pumps fell from 8% to below 2%.
Interpretation
Screening only for MRSA overlooks most *S. aureus* carriers in this population. The reduction observed after decolonization is clinically compelling, particularly for baclofen pumps, but the study cannot isolate decolonization from simultaneous changes in antibiotics, technique or perioperative care.
Limitations
This was a retrospective, single-surgeon experience spanning 11 years. The protocols changed over time rather than through random allocation, so secular improvements and differences between patient groups may explain part of the effect. The small number of deep infections limits precise comparative estimates.
Clinical takeaway
Before implanting neuromodulation hardware, screen for both MSSA and MRSA rather than MRSA alone. A structured decolonization pathway is especially reasonable for intrathecal baclofen-pump candidates, coupled with prospective surveillance of infections and protocol adherence.