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Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study
Paul D Sponseller1, Amit Jain, Suken A Shah
1*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE ‡Shriner's Hospital, Philadelphia, PA; and §Department of Orthopedics, Rady Children's Hospital of San Diego, CA.
Insights
Deep wound infection occurred in 6.4% of pediatric patients with cerebral palsy (CP) after spinal fusion. The presence of a gastrostomy/gastrojejunostomy tube significantly increased infection risk, with Gram-negative bacteria being common causes.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease
- Surgical Outcomes
Background:
- Spinal fusion in children with cerebral palsy (CP) has a higher incidence of wound infection compared to other diagnoses.
- Understanding infection risks is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the rate of deep wound infection in pediatric CP patients undergoing spinal fusion.
- To identify patient, laboratory, and surgical factors associated with deep wound infection.
- To identify the causative organisms of deep wound infections.
Main Methods:
- Prospective cohort study involving 204 pediatric patients with CP across 7 institutions.
- Univariate and multivariate regression analyses were used to identify significant risk factors for infection.
- Data collected included patient demographics, laboratory values, and surgical characteristics.
Main Results:
- A deep wound infection rate of 6.4% was observed, with a mean time to infection of 34.2 days.
- Multivariate analysis identified the presence of a gastrostomy/gastrojejunostomy tube as a significant predictor (1.9-fold increased risk).
- Escherichia coli was the most frequent causative organism, followed by other Gram-negative bacteria and polymicrobial infections.
Conclusions:
- Deep wound infection is a significant complication in pediatric CP patients after spinal fusion, occurring in 6.4% of cases.
- Gastrostomy/gastrojejunostomy tube use is a key risk factor for developing deep wound infections.
- Gram-negative bacteria are the primary pathogens; considering Gram-negative antibiotic prophylaxis may be beneficial.
Study Design:
Prospective cohort.
Objective:
To (1) calculate the rate of deep wound infection in children with cerebral palsy (CP) after spinal fusion surgery; (2) identify factors (patient, laboratory, and surgical) associated with deep wound infection development; and (3) report causative organisms.
Summary Of Background Data:
Wound infection after spine fusion for CP is more common than after spine fusion for most other diagnoses.
Methods:
We prospectively gathered data on 204 consecutive pediatric patients with CP who underwent surgery at 7 institutions. Univariate and multivariate regression analysis was performed to analyze patient, laboratory, and surgical characteristics to identify factors that were significantly associated with infection development. Statistical significance was set at a value of P less than 0.05.
Results:
Deep wound infection developed in 13 (6.4%) children. The mean time to infection development was 34.2 ± 60.2 days. On univariate analysis, older age, larger curve size, presence of gastrostomy/gastrojejunostomy tube, higher preoperative serum white blood cell count, and longer operative time were significantly associated with deep wound infection. On multivariate analysis, only the presence of a gastrostomy/gastrojejunostomy tube remained significant (1.9-fold risk of deep wound infection compared with patients without tubes). Escherichia coli was the most common organism cultured from the wound sites (5 patients). Other infective agents were: Pseudomonas aeruginosa (2), methicillin-susceptible Staphylococcus aureus (1), Proteus mirabilis (1), and polymicrobial organisms (4).
Conclusion:
Deep wound infection occurred in 6.4% of children with CP after spinal fusion. The presence of a gastrostomy/gastrojejunostomy tube was a significant predictor of infection. Gram-negative organisms were the most common causative agents. Surgeons should be cognizant of these factors when treating children with CP and may consider Gram-negative antibiotic prophylaxis.
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