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High prevalence of gram-negative and multiorganism surgical site infections after pediatric complex tethered spinal
Nikita G Alexiades1, Belinda Shao2, Edward S Ahn3
11Department of Neurosurgery, University of Arizona-Phoenix, Arizona.
Insights
Surgical site infections (SSIs) after complex tethered spinal cord (cTSC) release in children are frequently polymicrobial and gram-negative. Many of these infections show resistance to cefazolin, suggesting a need for broader antibiotic prophylaxis.
Area of Science:
- Pediatric Neurosurgery
- Infectious Disease
- Surgical Outcomes
Background:
- Surgical site infections (SSIs) are a complication of complex tethered spinal cord (cTSC) release in children.
- Patients undergoing cTSC release share similarities with those undergoing neuromuscular scoliosis correction, which has high rates of gram-negative and polymicrobial infections.
Purpose of the Study:
- To determine if findings from a single-center pilot study on SSIs after cTSC release are reproducible in a multicenter setting.
- To investigate the characteristics of microbial organisms isolated from SSIs following cTSC release.
Main Methods:
- A multicenter, retrospective chart review was conducted across 7 centers.
- Data were collected for cases of SSI following cTSC release between 2007 and 2017.
- Microbial culture data and antibiotic sensitivities were analyzed.
Main Results:
- An overall SSI rate of 6.7% was observed (44 SSIs out of 655 cases).
- 43% of SSIs were polymicrobial, and 66% involved at least one gram-negative organism.
- Half of SSIs contained organisms resistant to cefazolin, with only 32% fully susceptible.
Conclusions:
- Gram-negative and polymicrobial infections dominate SSIs after cTSC surgery.
- A significant proportion of these infections exhibit resistance to cefazolin.
- Broader gram-negative antibiotic prophylaxis should be considered for children undergoing cTSC release.
Objective:
Complex tethered spinal cord (cTSC) release in children is often complicated by surgical site infection (SSI). Children undergoing this surgery share many similarities with patients undergoing correction for neuromuscular scoliosis, where high rates of gram-negative and polymicrobial infections have been reported. Similar organisms isolated from SSIs after cTSC release were recently demonstrated in a single-center pilot study. The purpose of this investigation was to determine if these findings are reproducible across a larger, multicenter study.
Methods:
A multicenter, retrospective chart review including 7 centers was conducted to identify all cases of SSI following cTSC release during a 10-year study period from 2007 to 2017. Demographic information along with specific microbial culture data and antibiotic sensitivities for each cultured organism were collected.
Results:
A total of 44 SSIs were identified from a total of 655 cases, with 78 individual organisms isolated. There was an overall SSI rate of 6.7%, with 43% polymicrobial and 66% containing at least one gram-negative organism. Half of SSIs included an organism that was resistant to cefazolin, whereas only 32% of SSIs were completely susceptible to cefazolin.
Conclusions:
In this study, gram-negative and polymicrobial infections were responsible for the majority of SSIs following cTSC surgery, with approximately half resistant to cefazolin. Broader gram-negative antibiotic prophylaxis should be considered for this patient population.
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