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Nasal Swab Screening for Staphylococcus aureus in Spinal Deformity Patients Treated With Growing Rods.

Scott J Luhmann1, June C Smith2

  • 1Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital.

Journal of Pediatric Orthopedics
|September 11, 2019
PubMed
Summary

Preoperative Staphylococcus aureus (SA) screening in growing rod (GR) patients identified 26.5% needing altered antibiotics. This screening ensures appropriate SA coverage, reducing surgical-site infection risks in spinal procedures.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Microbiology

Background:

  • Surgical-site infections (SSIs) are a significant concern for patients undergoing growing rod (GR) procedures.
  • Staphylococcus aureus (SA) is a common pathogen implicated in SSIs.
  • Current prophylactic antibiotic strategies may not adequately cover resistant SA strains.

Purpose of the Study:

  • To evaluate the efficacy of preoperative Staphylococcus aureus (SA) screening in patients undergoing growing rod (GR) surgery.
  • To determine if SA screening allows for targeted adjustments in prophylactic antibiotic regimens.
  • To reduce the incidence of SSIs by optimizing antibiotic coverage based on identified SA resistances.

Main Methods:

  • Retrospective case series analysis of 34 patients undergoing GR procedures.
  • 111 preoperative SA screenings were performed, including nasal swabs.
  • Patients were categorized by spinal condition: neuromuscular (NMS), congenital, idiopathic scoliosis (IS), and syndromic.

Main Results:

  • 13 patients (38.2%) screened positive for SA (MRSA or MSSA) during their GR treatment course.
  • 9 patients (26.5%) demonstrated SA resistance to cefazolin, a common prophylactic antibiotic.
  • Targeted antibiotic adjustments based on screening results could have improved coverage for 26.5% of patients.

Conclusions:

  • Preoperative SA nasal swab screening is valuable in growing rod (GR) patients.
  • Screening identifies patients requiring modified prophylactic antibiotics for optimal SA coverage.
  • This approach can potentially mitigate the risk of SSIs in this vulnerable patient population.