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

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.

• Authors: Paul D Sponseller, Amit Jain, Suken A Shah, Amer Samdani, Burt Yaszay, Peter O Newton, Leslie-Marie Thaxton, Tracey P Bastrom, Michelle C Marks
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 38 Issue 23 Pg. 2023-7 (Nov 01 2013) ISSN: 1528-1159 [Electronic] United States
• PMID: 23963019 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Age Factors
• Cerebral Palsy (complications)
• Child
• Gastric Bypass (adverse effects, instrumentation)
• Gastrostomy (adverse effects, instrumentation)
• Humans
• Leukocyte Count
• Logistic Models
• Multivariate Analysis
• Prospective Studies
• Risk Factors
• Spinal Fusion (adverse effects)
• Spine (abnormalities, surgery)
• Surgical Wound Infection (diagnosis, etiology, microbiology)
• Time Factors
• United States