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Implant-associated Infection After Pediatric Spine Deformity Surgery: Is Removal of Hardware Indicated?
Jou Wei1, Conrad Brown1, Tomas Moore2
1From the Queensland Children's Hospital.
Insights
Pediatric spinal implant infections can be successfully treated with hardware retention in select cases, particularly when diagnosed early and associated with specific bacteria. Further research into prevention is recommended.
Area of Science:
- Pediatric Orthopedics
- Spinal Surgery
- Infectious Diseases
Background:
- Postoperative spinal implant infections in children pose significant management challenges.
- Characterizing these infections is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the experience with pediatric spinal implant infections at a tertiary referral center.
- To identify factors associated with successful management and implant retention.
Main Methods:
- Retrospective observational study of pediatric spinal surgery patients (2015-2021).
- Identification and analysis of surgical site infections, focusing on implant-associated cases.
- Review of prophylaxis, microbiology, clinical course, and outcomes.
Main Results:
- 35 surgical site infections (6.03%) and 9 implant-associated infections (1.55%) occurred in 580 children (933 procedures).
- Infection rates were higher in neuromuscular scoliosis (11.5%) than idiopathic scoliosis (3.89%).
- Four implant-associated infections were managed with hardware retention, presenting early (median 20 days) with Staphylococcus aureus or Pseudomonas aeruginosa.
Conclusions:
- Select pediatric spinal implant infections can be successfully treated with implant retention.
- Early diagnosis and specific organisms (Staphylococcus aureus, Pseudomonas aeruginosa) correlate with better retention outcomes.
- Preventative strategies are essential to avoid late-onset infections.
Background:
Postoperative spinal implant infection following pediatric spinal surgery often presents a management dilemma. We aimed to characterize our experience in this cohort of patients, hoping to provide further insight when approaching these challenging cases.
Methods:
A retrospective, observational study was performed of all children who underwent spinal surgery from January 2015 to June 2021 in a tertiary pediatric spinal surgery referral center in Queensland, Australia. Records were reviewed to identify cases of postoperative surgical site infection, with particular focus on children with infection directly involving implants. Preoperative prophylaxis, microbiology, clinical course and outcomes were analyzed.
Results:
A total of 580 children underwent 933 procedures during the study period. The most common pathology requiring surgery was idiopathic scoliosis in 257 children (44.3%) followed by neuromuscular scoliosis in 192 children (33.1%). There were 35 cases of surgical site infection (6.03%), and 9 were implant-associated (1.55%). Infection rate among children with neuromuscular spinal deformity was almost 3-fold higher (11.5%) than idiopathic (3.89%). Methicillin-sensitive Staphylococcus aureus was the most commonly isolated organism (n = 15). Four implant-associated infections were successfully managed with retention of implant; all were diagnosed within 32 days (median = 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa . Conversely, infections that necessitated implant removal had a more indolent onset (median = 175 days), and more often cultured Cutibacterium acnes and coagulase-negative Staphylococci .
Conclusions:
Postoperative spinal implant infection can be treated successfully with hardware retention in select cases. Earlier presentation and recognition appear to be associated with better rates of retention and are linked to certain organisms. Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections.
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