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Spine (Phila Pa 1976). 2013 Nov 1;38(23):2023-7. doi: 10.1097/BRS.0b013e3182a83e59.

Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study.

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  • 1*Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE ‡Shriner's Hospital, Philadelphia, PA; and §Department of Orthopedics, Rady Children's Hospital of San Diego, CA.

Abstract

STUDY DESIGN:

Prospective cohort.

OBJECTIVE:

To (1) calculate the rate of deep wound infection in children with cerebral palsy (CP) after spinal fusion surgery; (2) identify factors (patient, laboratory, and surgical) associated with deep wound infection development; and (3) report causative organisms.

SUMMARY OF BACKGROUND DATA:

Wound infection after spine fusion for CP is more common than after spine fusion for most other diagnoses.

METHODS:

We prospectively gathered data on 204 consecutive pediatric patients with CP who underwent surgery at 7 institutions. Univariate and multivariate regression analysis was performed to analyze patient, laboratory, and surgical characteristics to identify factors that were significantly associated with infection development. Statistical significance was set at a value of P less than 0.05.

RESULTS:

Deep wound infection developed in 13 (6.4%) children. The mean time to infection development was 34.2 ± 60.2 days. On univariate analysis, older age, larger curve size, presence of gastrostomy/gastrojejunostomy tube, higher preoperative serum white blood cell count, and longer operative time were significantly associated with deep wound infection. On multivariate analysis, only the presence of a gastrostomy/gastrojejunostomy tube remained significant (1.9-fold risk of deep wound infection compared with patients without tubes). Escherichia coli was the most common organism cultured from the wound sites (5 patients). Other infective agents were: Pseudomonas aeruginosa (2), methicillin-susceptible Staphylococcus aureus (1), Proteus mirabilis (1), and polymicrobial organisms (4).

CONCLUSION:

Deep wound infection occurred in 6.4% of children with CP after spinal fusion. The presence of a gastrostomy/gastrojejunostomy tube was a significant predictor of infection. Gram-negative organisms were the most common causative agents. Surgeons should be cognizant of these factors when treating children with CP and may consider Gram-negative antibiotic prophylaxis.

PMID:
23963019
[PubMed - indexed for MEDLINE]
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