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Orthopedic Device-related Infections in Children: Characteristics, Treatment and Outcomes
Marie Raphalen1, Léa Domitien Payet1, Joana Pissara2
1From the Pediatric Emergency and Post-emergency Department.
Insights
Orthopedic device-related infections (ODRI) in children are often caused by Staphylococcus aureus, with specific bacteria linked to scoliosis types. Management requires tailored antibiotic therapy based on infection source and patient factors for an 85% cure rate.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Site Infections
Background:
- Orthopedic device-related infections (ODRI) are significant postoperative complications.
- Data on pediatric ODRI are limited, lacking standardized management guidelines.
- This study aimed to characterize pediatric ODRI presentation, microbiology, treatment, and outcomes.
Purpose of the Study:
- To characterize the clinical presentation of pediatric ODRI.
- To analyze microbiological findings in pediatric ODRI.
- To evaluate therapeutic management and outcomes of ODRI in children.
Main Methods:
- Retrospective, observational study at Montpellier University Hospital (January 2015 - June 2023).
- Included children under 16 with ODRI diagnosis requiring surgical revision.
- Analyzed 69 ODRI cases.
Main Results:
- Staphylococcus aureus (SA) was the most common pathogen (39/69), especially in fracture-related ODRI (72%).
- Gram-negative bacteria (GNB) predominated in nonidiopathic scoliosis (50%), and anaerobic bacteria in idiopathic scoliosis (58%).
- The overall cure rate was 85%, with median total antibiotic duration of 60 days.
Conclusions:
- SA is the primary cause of pediatric ODRI.
- Specific bacterial profiles are associated with different orthopedic indications (fractures, scoliosis).
- Optimizing antibiotic prophylaxis and therapy duration is crucial, considering surgical indications and comorbidities.
Background:
Orthopedic device-related infection (ODRI) is a major postoperative complication encompassing a broad spectrum of clinical situations depending on the anatomical site, type of implanted material, and patient-specific factors. Despite their clinical significance, data on ODRIs in children are scarce and standardized management guidelines are lacking. Our aim was to characterize the clinical presentation, laboratory findings, microbiological characteristics, therapeutic management and outcomes of ODRIs in children.
Methods:
We conducted a retrospective, observational study at Montpellier University Hospital from January 2015 to June 2023. All children under 16 years with an ODRI diagnosis, defined as the presence of clinical signs requiring surgical revision, were included.
Results:
Sixty-nine ODRI cases were analyzed. Initial surgical indications were: 25 fractures, 16 cases of nonidiopathic scoliosis (NIS), 12 of idiopathic scoliosis (IS) and 16 other orthopedic anomalies. Infections were polymicrobial in 35% of cases. Staphylococcus aureus (SA) was isolated in 39/69 cases, Gram-negative bacteria (GNB) in 13/69 cases and anaerobic bacteria in 9/69 cases (none on fracture cases). SA was involved in 72% of fracture-related ODRI. 50% of NIS were affected by GNB and 58% of IS by anaerobic bacteria. Empirical antibiotic treatment was mainly piperacillin/tazobactam and vancomycin (n = 38). Median duration of intravenously antibiotic therapy was 15 days [interquartile range (IQR) 10-18.5]. Median duration of total antibiotic therapy was 60 days (IQR 44.5-92), 46.5 days (IQR 42-61.75) with implant removal and 63.5 days (IQR 42.25-96.5) with implant retention. The cure rate in our cohort was 85%.
Conclusions:
SA is the first cause of ODRIs in children. GNB predominates in the case of NIS and anaerobic bacteria in the case of IS. Surgical indications and comorbidities are essential to determine antibiotic prophylaxis, antibiotic therapy and optimize their duration.
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