Abstract
Objectives
To review the use of preoperative screening for Staphylococcus aureus for all pediatric spine procedures that was instituted at our facility in a multimodal approach to decrease the frequency of postoperative wound infections.
Summary of Background Data
Four years ago at our facility, a multimodal approach to decrease the frequency of postoperative infections after pediatric spine surgery was instituted.
Methods
A single-center, single-surgeon pediatric spine surgery database was queried to identify all patients who had preoperative S. aureus nasal swab screening. Data collected included demographic data, diagnoses, methicillin-resistant S. aureus (MRSA) swab findings, bacterial antibiotic sensitivities, and outcome of the spine surgery.
Results
A total of 339 MRSA screenings were performed. Twenty (5.9%) were MRSA positive, and 55 (16.2%) were methicillin-sensitive S. aureus (MSSA) positive. In the MRSA-positive group, 13 were neuromuscular, 5 were adolescent idiopathic scoliosis (AIS), 1 congenital, and 1 infantile idiopathic scoliosis. Of the MRSA-positive screenings, 13 (65.0% of MRSA-positive screenings; 3.8% of entire cohort) of were newly identified cases (9 neuromuscular, 3 AIS, and 1 congenital diagnoses). In the 55 MSSA-positive, 6 documented resistance to either cefazolin or clindamycin. Hence, in up to 22 of the preoperative screenings (6.5% of entire cohort; 16 MRSA and 6 MSSA showed antibiotic resistance), the preoperative antibiotic regimen could be altered to appropriately cover the identified bacterial resistances. During the study period, there were 11 patients who were diagnosed with a postoperative deep wound infection, none of them having positive screenings.
Conclusion
The use of preoperative nasal swab MRSA screening permitted adjustment of the preoperative antibiotic regimen in up to 6.5% of patients undergoing pediatric spine surgery. This inexpensive, noninvasive tool can be used in preoperative surgical planning for all patients undergoing spinal procedures.
Level of Evidence
Level IV.
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References
Cahill PJ, Warnick DE, Lee MJ, et al. Infection after spinal fusion for pediatric spinal deformity: thirty years of experience at a single institution. Spine 2010;35:1211–7.
Chen AF, Chivukula S, Jacobs LJ, et al. What is the prevalence of MRSA colonization in elective spine cases? Clin Orthop Relat Res 2012;470:2684–9.
Labbe AC, Demers AM, Rodrigues R, et al. Surgical-site infection following spinal fusion; a case-control study in a children’s hospital. Infect Control Hosp Epidemiol 2003;24:591–5.
Li Y, Glotzbecker M, Hedequist D. Surgical site infection after pediatric spinal deformity surgery. Curr Rev Musculoskelet Med 2012;5:111–9.
Nandyala SV, Schwend RM. Prevalence of intraoperative tissue bacterial contamination in posterior pediatric spinal deformity surgery. Spine 2013;38:E482–6.
Theologis AA, Demirkiran G, Callahan M, et al. Local intrawound vancomycin powder decreases the risk of surgical site infections in complex adult deformity reconstruction: a cost analysis. Spine 2014;39:1875–80.
Abdul-Jabbar A, Berven SH, Hu SS, et al. Surgical site infections in spine surgery: identification of microbiologic and surgical characteristics in 239 cases. Spine 2013;38:E1425–31.
Hidron AI, Edwards JR, Patel J, et al. National Healthcare Safety Network Team; Participating National Healthcare Safety Network Facilities. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29:996–1011.
Chen AF, Wessel CB, Rao N. Staphylococcus aureus screening and decolonization in orthopaedic surgery and reduction of surgical site infections. Clin Orthop 2013;471:2383–99.
Vitale MG, Riedel MD, Glotzbecker M, et al. Building consensus: development of a best practice guideline (BPG) for surgical site infections (SSI) prevention in high risk pediatric spine surgery. J Pediatr Orthop 2013;33:471–8.
Glotzbecker MP, Garg S, Akbarnia BA, et al. Surgeon practices regarding infection prevention for growth friendly spinal procedures. J Child Orthop 2014;8:245–50.
Glotzbecker MP, Vitale MG, Shea KG, et al. POSNA committee on the Quality, Safety, Value Initiative (QSVI). J Pediatr Orthop 2013;33:694–9.
Sweet FA, Roth M, Sliva C. Intrawound application of vancomycin for prophylaxis in instrumented thoracolumbar fusion: efficacy, drug level, and patient outcomes. Spine 2011;36:2084–8.
Gans I, Dormans JP, Spiegel DA, et al. Adjunctive vancomycin powder in pediatric spine surgery is safe. Spine 2013;38:1703–7.
Zebala LP, Chuntarapas T, Kelly MP, et al. Intrawound vancomycin powder eradicates surgical wound contamination: an in vivo rabbit study. J Bone Joint Surg Am 2014;96:46–51.
Thakkar V, Ghobrial GM, Maulucci CM, et al. Nasal MRSA colonization: impact on surgical site infection following spine surgery. Clin Neurol Neurosurg 2014;125:94–7.
Calderone RR, Garland DE, Capen DA, et al. Cost of medical care for postoperative spinal infections. Orthop Clin North Am 1996;27:171–82.
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SJL (personal fees from Medtronic, personal fees from Stryker, personal fees from Orthofix, outside the submitted work; In addition, Dr. Luhmann has a patent with Lippincott with royalties paid, and a patent with Globus Medical with royalties paid), JCS (none).
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Luhmann, S.J., Smith, J.C. Preoperative MRSA Screening in Pediatric Spine Surgery: A Helpful Tool or a Waste of Time and Money?. Spine Deform 4, 272–276 (2016). https://doi.org/10.1016/j.jspd.2015.12.006
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DOI: https://doi.org/10.1016/j.jspd.2015.12.006