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A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens.
Spine Deform 2019; 7(4):647-651SD

Abstract

STUDY DESIGN

Retrospective descriptive.

OBJECTIVES

Identify incidence and risk of deep surgical site infections (SSIs), associated pathogens, and antibiotic susceptibility in patients with nonidiopathic early-onset scoliosis (EOS) undergoing growth-friendly (GF) spine surgery.

BACKGROUND

SSIs following GF procedures for EOS are well described, but epidemiologic trends in associated pathogens have not been well characterized.

METHODS

The Children's Spine Study Group database was queried for children ≤18 years of age undergoing GF procedures for nonidiopathic EOS at 11 institutions from September 2001 to January 2016. Deep SSIs reported within 90 days of procedures were reviewed for associated pathogens and their susceptibility profiles. Data were analyzed to calculate incidence and risk.

RESULTS

593 patients (median age 5.7 years, IQR 3.3-8.0 years) with scoliosis due to congenital (45%), neuromuscular (39%), and syndromic (16%) disorders underwent 5,072 procedures. The incidence of deep SSIs per patient was 12.6%; 75 patients had one or more deep SSIs. The risk of deep SSIs per procedure was 1.95% as 99 SSIs occurred after the 5072 procedures. Overall, 48% of deep SSIs followed expansion procedures. Pathogen(s) were cultured from 92% of SSIs including gram-positive cocci (GPC, 90.1%) and/or gram-negative rods (GNR, 17.6%). Methicillin-susceptible Staphylococcus aureus (48.4% of SSIs), methicillin-resistant S. aureus (23.1%), and coagulase negative staphylococci (CoNS, 8.8%) were the most common GPCs. Escherichia coli (5.5% of SSIs), Enterobacter cloacae (4.4%), and Pseudomonas aeruginosa (4.4%) were the most common among GNRs. GNR susceptibility to cefazolin was 41% during the study period, whereas GPC susceptibility to cefazolin was 59%.

CONCLUSION

The risk of SSIs can potentially be reduced for this vulnerable population by routinely reviewing the local epidemiology of SSIs, including the associated pathogens and their susceptibility patterns. As GNR susceptibility to cefazolin was only 41%, expanding prophylaxis to include aminoglycosides for GNR is prudent.

LEVEL OF EVIDENCE

Level IV.

Authors+Show Affiliations

Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.Shriners Hospitals for Children, 3551 N Broad St, Philadelphia, PA 19140, USA.Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19140, USA.Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA. Electronic address: ls5@cumc.columbia.edu.Children's Spine Foundation, Valley Forge, PA 19481, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31202384

Citation

Minkara, Anas A., et al. "A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens." Spine Deformity, vol. 7, no. 4, 2019, pp. 647-651.
Minkara AA, Matsumoto H, Glotzbecker M, et al. A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens. Spine Deform. 2019;7(4):647-651.
Minkara, A. A., Matsumoto, H., Glotzbecker, M., Samdani, A., Flynn, J., Vitale, M. G., & Saiman, L. (2019). A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens. Spine Deformity, 7(4), pp. 647-651. doi:10.1016/j.jspd.2018.11.015.
Minkara AA, et al. A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens. Spine Deform. 2019;7(4):647-651. PubMed PMID: 31202384.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens. AU - Minkara,Anas A, AU - Matsumoto,Hiroko, AU - Glotzbecker,Michael, AU - Samdani,Amer, AU - Flynn,John, AU - Vitale,Michael G, AU - Saiman,Lisa, AU - ,, PY - 2018/05/15/received PY - 2018/11/13/revised PY - 2018/11/20/accepted PY - 2019/6/17/entrez PY - 2019/6/17/pubmed PY - 2019/6/17/medline KW - Antibiotic prophylaxis KW - Early onset scoliosis KW - Nonidiopathic scoliosis KW - Surgical site infection SP - 647 EP - 651 JF - Spine deformity JO - Spine Deform VL - 7 IS - 4 N2 - STUDY DESIGN: Retrospective descriptive. OBJECTIVES: Identify incidence and risk of deep surgical site infections (SSIs), associated pathogens, and antibiotic susceptibility in patients with nonidiopathic early-onset scoliosis (EOS) undergoing growth-friendly (GF) spine surgery. BACKGROUND: SSIs following GF procedures for EOS are well described, but epidemiologic trends in associated pathogens have not been well characterized. METHODS: The Children's Spine Study Group database was queried for children ≤18 years of age undergoing GF procedures for nonidiopathic EOS at 11 institutions from September 2001 to January 2016. Deep SSIs reported within 90 days of procedures were reviewed for associated pathogens and their susceptibility profiles. Data were analyzed to calculate incidence and risk. RESULTS: 593 patients (median age 5.7 years, IQR 3.3-8.0 years) with scoliosis due to congenital (45%), neuromuscular (39%), and syndromic (16%) disorders underwent 5,072 procedures. The incidence of deep SSIs per patient was 12.6%; 75 patients had one or more deep SSIs. The risk of deep SSIs per procedure was 1.95% as 99 SSIs occurred after the 5072 procedures. Overall, 48% of deep SSIs followed expansion procedures. Pathogen(s) were cultured from 92% of SSIs including gram-positive cocci (GPC, 90.1%) and/or gram-negative rods (GNR, 17.6%). Methicillin-susceptible Staphylococcus aureus (48.4% of SSIs), methicillin-resistant S. aureus (23.1%), and coagulase negative staphylococci (CoNS, 8.8%) were the most common GPCs. Escherichia coli (5.5% of SSIs), Enterobacter cloacae (4.4%), and Pseudomonas aeruginosa (4.4%) were the most common among GNRs. GNR susceptibility to cefazolin was 41% during the study period, whereas GPC susceptibility to cefazolin was 59%. CONCLUSION: The risk of SSIs can potentially be reduced for this vulnerable population by routinely reviewing the local epidemiology of SSIs, including the associated pathogens and their susceptibility patterns. As GNR susceptibility to cefazolin was only 41%, expanding prophylaxis to include aminoglycosides for GNR is prudent. LEVEL OF EVIDENCE: Level IV. SN - 2212-1358 UR - https://www.unboundmedicine.com/medline/citation/31202384/A_Multicenter_Study_of_the_Epidemiology_of_Deep_Surgical_Site_Infections_in_Children_With_Nonidiopathic_Early-Onset_Scoliosis_Including_Associated_Pathogens L2 - https://linkinghub.elsevier.com/retrieve/pii/S2212-134X(18)30293-4 DB - PRIME DP - Unbound Medicine ER -