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Surgical-Site Infection Following Spinal Fusion: A Case-Control Study in a Children's Hospital

Published online by Cambridge University Press:  02 January 2015

Annie-Claude Labbé ,
Anne-Marie Demers ,
Ramona Rodrigues ,
Vincent Arlet ,
Kim Tanguay  and
Dorothy L. Moore
Annie-Claude Labbé
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Anne-Marie Demers
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Ramona Rodrigues
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Vincent Arlet
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Kim Tanguay
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Dorothy L. Moore*
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
*
Montreal Children's Hospital, Room C1242, 2300 Tupper Street, Montreal, Quebec, Canada H3H 1P3
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Abstract

Objectives:

To determine the rates of surgical-site infections (SSIs) after spinal surgery and to identify the risk factors associated with infection.

Design:

SSIs had been identified by active prospective surveillance. A case-control study to identify risk factors was performed retrospectively.

Setting:

University-associated, tertiary-care pediatric hospital.

Patients:

All patients who underwent spinal surgery between 1994 and 1998. Cases were all patients who developed an SSI after spinal surgery. Controls were patients who did not develop an SSI, matched with the cases for the presence or absence of myelodysplasia and for the surgery date closest to that of the case.

Results:

There were 10 infections following 125 posterior spinal fusions, 4 infections after 50 combined anterior-posterior fusions, and none after 95 other operations. The infection rate was higher in patients with myelodysplasia (32 per 100 operations) than in other patients (3.4 per 100 operations; relative risk = 9.45; P < .001). Gram-negative organisms were more common in early infections and Staphylococcus aureus in later infections. Most infections occurred in fusion involving sacral vertebrae (odds ratio [OR] = 12.0; P = .019). Antibiotic prophylaxis was more frequently suboptimal in cases than in controls (OR = 5.5; P = .034). Five patients required removal of instrumentation and 4 others required surgical debridement.

Conclusions:

Patients with myelodysplasia are at a higher risk for SSIs after spinal fusion. Optimal antibiotic prophylaxis may reduce the risk of infection, especially in high-risk patients such as those with myelodysplasia or those undergoing fusion involving the sacral area.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 8 , August 2003 , pp. 591 - 595
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Banit, DM, Iwinski, HJ Jr, Talwalkar, V, Johnson, M. Posterior spinal fusion in paralytic scoliosis and myelomeningocele. J Pediatr Orthop 2001;21:117–125.CrossRefGoogle ScholarPubMed
2.Benson, ER, Thomson, JD, Smith, BG, Banta, JV. Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine 1998;23:2308–2317.CrossRefGoogle Scholar
3.Lonstein, J, Winter, R, Moe, J, Gaines, D. Wound infection with Harrington instrumentation and spine fusion for scoliosis. Clin Orthop 1973;96:222–233.CrossRefGoogle Scholar
4.Massie, JB, Heller, JG, Abitbol, JJ, McPherson, D, Garfin, SR. Postoperative posterior spinal wound infections. Clin Orthop 1992;284:99–108.CrossRefGoogle Scholar
5.Perry, JW, Montgomerie, JZ, Swank, S, Gilmore, DS, Maeder, K. Wound infections following spinal fusion with posterior segmental spinal instrumentation. Clin Infect Dis 1997;24:558–561.Google Scholar
6.Szoke, G, Iipton, G, Miller, F, Dabney, K. Wound infection after spinal fusion in children with cerebral palsy. J Pediatr Orthop 1998;18:727–733.CrossRefGoogle ScholarPubMed
7.Theiss, SM, Lonstein, JE, Winter, RB. Wound infections in reconstructive spine surgery. Orthop Clin North Am 1996;27:105–110.CrossRefGoogle ScholarPubMed
8.Transfeldt, E, Lonstein, J, Winter, R, Bradford, D, Moe, J, Mayfield, J. Wound infections in reconstructive spinal surgery. Orthop Trans 1985;9:128–129.Google Scholar
9.Wimmer, C, Gluch, H. Management of postoperative wound infection in posterior spinal fusion with instrumentation. J Spinal Disord Tech 1996;9:505–508.Google Scholar
10.Banta, JV. Combined anterior and posterior fusion for spinal deformity in myelomeningocele. Spine 1990;15:946–952.CrossRefGoogle ScholarPubMed
11.Stella, G, Ascani, E, Cervellati, S, et al.Surgical treatment of scoliosis associated with myelomeningocele. Eur J Pediatr Surg 1998;8(suppl 1):22–25.CrossRefGoogle ScholarPubMed
12.Horan, TC, Gaynes, RP, Marione, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control 1992;20:271–274.CrossRefGoogle ScholarPubMed
13. Anonymous. Antimicrobial prophylaxis in surgery. Med Lett Drugs Ther 1999;41:75–79.Google Scholar
14.Sponseller, PD, LaPorte, DM, Hungerford, MW, Eck, K, Bridwell, KH, Lenke, LG. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine 2000;25:2461–2466.CrossRefGoogle ScholarPubMed
15.Richards, BS. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg Am 1995;77:524–529.CrossRefGoogle ScholarPubMed
16.Viola, RW, King, HA, Adler, SM, Wilson, CB. Delayed infection after elective spinal instrumentation and fusion: a retrospective analysis of eight cases. Spine 1997;22:2444–2450.CrossRefGoogle ScholarPubMed