Surgical site infections in pediatric orthopedic surgery

Surgical site infections (SSIs) represent a major complication in pediatric orthopedics and occur predominantly after spinal surgery for scoliosis. Diagnosis relies on clinical signs, inflammatory biomarkers, and deep intraoperative microbiological sampling obtained prior to antibiotic administration whenever possible. In cases of negative cultures, particularly after prior antibiotic exposure, molecular techniques such as 16S rRNA polymerase chain reaction may improve pathogen identification. The microbiological profile varies according to the underlying condition. Idiopathic scoliosis is mainly associated with Gram-positive organisms, particularly Staphylococcus aureus and Cutibacterium acnes, whereas neuromuscular scoliosis more frequently involves Gram-negative bacilli. Identified risk factors include malnutrition, neurological disorders, diabetes, prolonged operative time, extensive instrumentation, and the presence of medical devices. Preventive measures include appropriate skin preparation with Staphylococcus aureus decolonization when indicated, antiseptic showering, optimization of nutritional status, and perioperative antibiotic prophylaxis, typically cefazolin with or without additional Gram-negative coverage in high-risk patients. Postoperative continuation of prophylaxis is not recommended. Intraoperative measures such as maintenance of normothermia and early drain removal also contribute to reducing infection risk. Management requires a multidisciplinary approach. Antibiotic therapy is initiated after microbiological sampling, adapted to culture results, and continued for 6 to 12 weeks. Implant retention is preferred whenever possible until bone fusion is achieved. Further efforts, including national registries and dedicated multidisciplinary networks, are needed to improve prevention and management strategies in pediatric patients.