Related Experiment Video
Updated: Mar 19, 2026
In Vivo Mouse Model of Spinal Implant Infection
Published on: June 23, 2020
Epidemiology of Deep Surgical Site Infections After Pediatric Spinal Fusion Surgery
Stephen J Warner1, Tyler J Uppstrom1, Andy O Miller1
1Hospital for Special Surgery, New York, NY.
Insights
The microbiology of deep surgical site infections (SSIs) after pediatric spinal deformity surgery has remained stable over 13 years. However, gram-positive and gram-negative coverage may be needed for neuromuscular diagnoses.
Area of Science:
- Pediatric Orthopedics
- Infectious Disease Epidemiology
- Surgical Site Infections
Background:
- Surgical site infections (SSIs) following pediatric spinal deformity surgery increase morbidity and healthcare costs.
- Antibiotic prophylaxis strategies rely on historical infection data, which may not reflect current trends.
- Understanding evolving SSI microbiology is crucial for effective treatment and prevention.
Purpose of the Study:
- To assess changes in the microbiology of deep SSIs after spinal fusion for deformity over a 13-year period.
- To identify common pathogens and trends in pediatric spinal deformity surgery-related SSIs.
- To inform antibiotic prophylaxis and treatment guidelines based on current epidemiological data.
Main Methods:
- Retrospective case series of pediatric patients (<21 years) undergoing spinal deformity surgery between 2000 and 2012.
- Inclusion criteria: index surgery at the institution and development of deep SSI; exclusion: growth-preserving constructs.
- Analysis of clinical and microbiology records to determine SSI incidence and causative organisms.
Main Results:
- Overall deep SSI incidence was 3.6%, with higher rates after revision surgery (8.3%) and in specific diagnoses like neuromuscular (14.3%).
- Most common pathogens included Staphylococcus epidermidis (26%), MSSA (18%), P. acnes (18%), and E. coli (18%).
- No significant changes in the incidence of MSSA, MRSA, or P. acnes were observed between 2000-2006 and 2007-2012.
Conclusions:
- The epidemiology of deep SSIs following pediatric spinal fusion for deformity has not significantly changed over the study period.
- Gram-negative infections were more prevalent in patients with neuromuscular diagnoses.
- Prophylactic antibiotic regimens may need to include both gram-positive and gram-negative coverage for pediatric patients with neuromuscular spinal deformities.
Study Design:
Single-institution, retrospective case series.
Objective:
To determine whether the microbiology of deep surgical site infections (SSIs) after spinal fusion surgery for deformity has changed over the last decade at our institution.
Summary Of Background Data:
SSI after pediatric spinal deformity surgery results in significantly increased patient morbidity and health care costs. Although risk factors are multifactorial, prophylactic and treatment antibiotic coverage is based in part on historical epidemiologic data, which may evolve over time.
Methods:
This study represents a retrospective review of clinical and microbiology records of patients less than 21 years old who underwent spinal deformity surgery at a single institution between 2000 and 2012. Patients were included who underwent index surgery at our institution and developed a deep SSI. Patients with growth-preserving spine constructs were excluded.
Results:
The overall incidence of deep SSI was 3.6% (39/1094). The incidence of deep SSI following primary surgery was 3.3% (34/1034) and 8.3% (5/60) following revision surgery. The incidence of deep SSI varied by primary diagnosis: idiopathic (1.0%), neuromuscular (14.3%), syndromic (5.3%), congenital (5.7%), and kyphosis (0.0%). The most common inciting pathogens were Staphylococcus epidermidis (26%), methicillin-sensitive Staphylococcus aureus (MSSA, 18%), Propionibacterium acnes (P. acnes; 18%), and Escherichia coli (18%). Sixteen of the 18 (89%) gram-negative infections occurred in neuromuscular patients (P = 0.006). Between 2000 and 2006 and between 2007 and 2012, MSSA occurred in 2/18 (11%) and 5/21 (24%) of cases (P = 0.41), methicillin-resistant S. aureus occurred in 1/18 (6%) and 3/21 (14%) (P = 0.61), and P. acnes occurred in 3/18 (17%) and 4/21 (19%) (P = 1.0).
Conclusion:
The epidemiology of deep SSI following spinal fusion for deformity in pediatric patients at our institution has not changed significantly during 13 years. Prophylactic antibiotic coverage for both gram-positive and gram-negative organisms may be indicated for patients with primary neuromuscular diagnoses.
Level Of Evidence:
4.
