Background: Intrathecal baclofen (ITB) therapy is an increasingly utilized modality in spasticity management.Clinicians need to be familiar with potential complications of the therapy.Case Report: A 34 year old black male with chronic quadriplegia from traumatic myelopathy underwent implantation of an ITB pump for management of intractable spasticity. His ITB dosing was titrated for six months post-implantation. He was maintained on 600 micrograms of ITB per day, delivered in a simple continuous fashion. Approximately nine months post implant, the patient was admitted to an acute care hospital for an elective cystoscopic sphincterotomy for bladder outlet obstruction. The patient received pre-operative antibiotic prophylaxis withcefazolin. The urological procedure was uneventful. Eight hours after the procedure, the patient’s temperature rose to 38.3 C. Over the next 12 hours, the patient developed mental status changes and incurred a single seizure episode. Ultrasonography demonstrated significant fluid surrounding the patient’s pump. Surgical exploration of the pump revealed purulent material. The pump and catheter were explanted emergently. Culture of the surrounding fluid grew out Enterococcus. The patient completed a six week course of intravenousantibiotics. The patient suffered no long term sequelae from this episode. His spasticity remained intractable to conservative measures and ultimately required cervical myelotomy for management.Conclusions: No validated standards of care exist for routine antibiotic prophylaxis for individuals with implanted ITB pumps. Clinicians should consider the possibility of CNS infection when determining the antimicrobial regimens in these patients.

Keywords: intrathecal baclofen, antibiotic prophyalxis, Quadriplegia, spasticity