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Prevalence of intraoperative tissue bacterial contamination in posterior pediatric spinal deformity surgery
Sreeharsha V Nandyala1, Richard M Schwend
1University of Missouri-Kansas City, School of Medicine, Kansas City, MO, USA.
Insights
Intraoperative bacterial contamination is common in pediatric spinal surgery, especially in older children and those with neuromuscular conditions. Treating back acne may reduce infection risk.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Infectious Disease
Background:
- Deep surgical site infections in pediatric spinal deformity surgery range from 1% to 14%.
- Limited data exists on intraoperative bacterial contamination during these procedures.
Purpose of the Study:
- To determine the prevalence of intraoperative bacterial contamination.
- To identify risk factors associated with contamination in pediatric posterior spinal deformity surgery.
Main Methods:
- Retrospective case-control study of 114 pediatric posterior instrumented deformity surgeries.
- Cultures of paraspinal muscle debrided before closure were analyzed.
- Patient factors, including age and presence of back acne, were correlated with contamination.
Main Results:
- 23% of cultures were positive, with higher rates in neuromuscular (37%) and older (≥11 years) patients.
- Propionibacterium acnes was the most common contaminant (69%), linked to back acne and older age.
- Pelvic fusion in neuromuscular patients was associated with positive cultures (42%).
Conclusions:
- Neuromuscular status, pelvic fusion, age over 11, and back acne are risk factors for contamination.
- Back acne is a modifiable risk factor for P. acnes contamination.
- Findings suggest tailoring prophylactic antibiotics and infection prevention strategies based on patient age and surgical factors.
Study Design:
Retrospective case control study.
Objective:
To determine prevalence and risk factors for intraoperative bacterial contamination in posterior spinal deformity surgery.
Summary Of Background Data:
The prevalence of deep surgical site infection in pediatric spinal deformity surgery varies from 1% to 14%. Little evidence exists about the incidence and role of intraoperative bacterial contamination.
Methods:
A total of 114 cases of pediatric posterior instrumented deformity surgery were retrospectively identified. All patients received preoperative and every 4-hour intraoperative antibiotics and 3M Ioban 2 Antimicrobial Incise Drape. Preoperative photographs of patients' backs were used to correlate presence of back acne with contaminant bacteria. Laboratory cultures were obtained from paraspinal muscle debrided before closure.
Results:
Of the 114 cultures obtained, 26 (23%) were positive in 21% of idiopathic, 37% of neuromuscular (P = 0.02), and 14% of congenital patients. Contaminant bacteria included Propionibacterium acnes (69%), Staphylococcus (23%), Coryneform (4%), and Clostridium (4%). P. acnes was seen only in children 11 years or older (P = 0.02) and only with back acne (P < 0.0001). Eight of 19 (42%) patients with pelvic fusion had positive cultures (P = 0.04) and all 8 were neuromuscular patients. Eighty-one percent of culture-positive patients were older than 11 years (P = 0.01). Three of 114 (2.7%) patients developed an early deep surgical site infection, all with positive cultures (P = 0.01).
Conclusion:
Neuromuscular patients fused to the pelvis, children older than 11 years, and surgery duration greater than 6 hours were associated with positive cultures. Back acne is a preventable risk factor for P. acnes seeding. Intraoperative bacterial contamination indicates a need to consider the type of surgery and patient age to determine prophylactic antibiotics and other modalities to prevent infection.
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