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A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens

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Abstract

Study Design

Retrospective descriptive.

Objectives

Identify incidence and risk of deep surgical site infections (SSIs), associated pathogens, and antibiotic susceptibility in patients with nonidiopathic early-onset scoliosis (EOS) undergoing growth-friendly (GF) spine surgery.

Background

SSIs following GF procedures for EOS are well described, but epidemiologic trends in associated pathogens have not been well characterized.

Methods

The Children’s Spine Study Group database was queried for children ≤18 years of age undergoing GF procedures for nonidiopathic EOS at 11 institutions from September 2001 to January 2016. Deep SSIs reported within 90 days of procedures were reviewed for associated pathogens and their susceptibility profiles. Data were analyzed to calculate incidence and risk.

Results

593 patients (median age 5.7 years, IQR 3.3–8.0 years) with scoliosis due to congenital (45%), neuromuscular (39%), and syndromic (16%) disorders underwent 5,072 procedures. The incidence of deep SSIs per patient was 12.6%; 75 patients had one or more deep SSIs. The risk of deep SSIs per procedure was 1.95% as 99 SSIs occurred after the 5072 procedures. Overall, 48% of deep SSIs followed expansion procedures. Pathogen(s) were cultured from 92% of SSIs including gram-positive cocci (GPC, 90.1%) and/or gram-negative rods (GNR, 17.6%). Methicillin-susceptible Staphylococcus aureus (48.4% of SSIs), methicillin-resistant S. aureus (23.1%), and coagulase negative staphylococci (CoNS, 8.8%) were the most common GPCs. Escherichia coli (5.5% of SSIs), Enterobacter cloacae (4.4%), and Pseudomonas aeruginosa (4.4%) were the most common among GNRs. GNR susceptibility to cefazolin was 41% during the study period, whereas GPC susceptibility to cefazolin was 59%.

Conclusion

The risk of SSIs can potentially be reduced for this vulnerable population by routinely reviewing the local epidemiology of SSIs, including the associated pathogens and their susceptibility patterns. As GNR susceptibility to cefazolin was only 41%, expanding prophylaxis to include aminoglycosides for GNR is prudent.

Level of Evidence

Level IV.

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Author information

Authors and Affiliations

  1. Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA

    Anas A. Minkara BHS, Hiroko Matsumoto MA, MPhil, Michael G. Vitale MD, MPH & Lisa Saiman MD, MPH

  2. Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Michael Glotzbecker MD

  3. Shriners Hospitals for Children, 3551 N Broad St, Philadelphia, PA, 19140, USA

    Amer Samdani MD

  4. Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19140, USA

    John Flynn MD

  5. Pediatric Infectious Diseases, Columbia University Medical Center, 650 West 168th St PH 4-470, New York, NY, 10032, USA

    Lisa Saiman MD, MPH

Authors
  1. Anas A. Minkara BHS
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  2. Hiroko Matsumoto MA, MPhil
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  3. Michael Glotzbecker MD
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  6. Michael G. Vitale MD, MPH
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Consortia

Children’s Spine Study Group

Corresponding author

Correspondence to Lisa Saiman MD, MPH.

Additional information

Author disclosures: AAM (none), HM (other from Children’s Spine Study Group [CSSG], Pediatric Orthopaedic Society of North America[POSNA], Scoliosis Research Society, Setting Scoliosis Straight Foundation, and from Children’s Spine Foundation [CSF], outside the submitted work), MG (other from Orthobullets, NuVasive, Medtronic, DePuy, Zimmer Biomet, and Growing Spine Study Group, CSSG, and The Harms Study Group, outside the submitted work), AS (personal fees from DePuy Synthes Spine, Ethicon, Globus Medical, NuVasive, Stryker, and Zimmer Biomet, outside the submitted work), JF (none), MGV (personal fees from Biomet and ECOP; grants from CSF, Setting Scoliosis Straight Foundation, Scoliosis Research Society, POSNA, and OMeGA; personal fees from Strykery and NuVasive, other from Wellinks, outside the submitted work), LS (grants from Merck; other from Cystic Fibrosis Foundation, Teva, and AB Comm, Inc., outside the submitted work), Children’s Spine Study Group (other from CSF; grants from DePuy Synthes Spine and NuVasive, outside the submitted work).

This work was performed at the Columbia University Medical Center, New York, NY.

Funding: No funding was provided for this research study.

IRB Approval: This work is approved by the Institutional Review Board at Columbia University Medical Center (Protocol AAAR0162).

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Minkara, A.A., Matsumoto, H., Glotzbecker, M. et al. A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens. Spine Deform 7, 647–651 (2019). https://doi.org/10.1016/j.jspd.2018.11.015

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