From the Department of Pediatrics.
Department of Infectious Diseases and Intensive Care Unit.
Pediatr Infect Dis J. 2018 Jun;37(6):511-513. doi: 10.1097/INF.0000000000001812.
Postoperative infection is a major complication of spinal surgery with implants. We aimed to identify risk factors for, and characteristics of, postoperative spinal infections in children.
We performed a retrospective observational study of all children who underwent posterior spinal fusion with instrumentation in 2 referral hospitals in 2008-2013. Spinal infections were defined as local and/or general signs of infection that required surgical treatment in the early postoperative phase (ie, within 30 days). Data were collected on a standardized questionnaire from medical charts.
Of the 450 children who underwent spinal surgery, 26 (5.8%) were diagnosed with early postoperative spinal implant infection, with a median age of 14 years (interquartile range, 13-17) and a median delay of 13 days postsurgery (interquartile range, 7-18). Postoperative infection was more common in children with neurologic scoliosis as compared with idiopathic scoliosis (12.2% [15/123] versus 2.4% [5/211]; P < 0.01). Neurologic scoliosis was an independent predictor of spinal implant infections (hazard ratio, 3.87 [1.72-8.69]; P < 0.001). Main pathogens were Staphylococcus aureus (n = 14) and Enterobacteriaceae (n = 8). All children underwent early surgery (wound exploration, debridement and lavage) and antibiotics for a median duration of 19 weeks [interquartile range, 12-26]. Two children (7.7%) required a second surgery. Spinal implants could be retained in all, and no relapse occurred with a follow-up of ≥24 months after antibiotic discontinuation.
Postoperative spinal implant infection is not rare in pediatric patients, especially with neurologic scoliosis. Most children may be cured with implant retention if managed with early surgery followed by a 3-month course of appropriate antibacterial agents.
术后感染是脊柱植入术后的主要并发症。我们旨在确定儿童术后脊柱感染的危险因素和特征。
我们对 2008 年至 2013 年在 2 家转诊医院接受后路脊柱融合内固定术的所有儿童进行了回顾性观察性研究。脊柱感染的定义为术后早期（即 30 天内）需要手术治疗的局部和/或全身感染迹象。数据是从病历的标准化问卷中收集的。
在接受脊柱手术的 450 名儿童中，有 26 名（5.8%）被诊断为术后早期脊柱植入物感染，中位年龄为 14 岁（四分位距 13-17 岁），中位术后时间为 13 天（四分位距 7-18 天）。与特发性脊柱侧凸相比，神经源性脊柱侧凸患儿术后感染更为常见（12.2%[15/123]与 2.4%[5/211]；P<0.01）。神经源性脊柱侧凸是脊柱植入物感染的独立预测因子（危险比 3.87[1.72-8.69]；P<0.001）。主要病原体为金黄色葡萄球菌（n=14）和肠杆菌科（n=8）。所有患儿均接受早期手术（伤口探查、清创和冲洗）和抗生素治疗，中位疗程为 19 周（四分位距 12-26 周）。2 名患儿（7.7%）需要再次手术。所有患儿均保留了脊柱植入物，且在停药后至少 24 个月的随访中未复发。
儿童术后脊柱植入物感染并不罕见，尤其是神经源性脊柱侧凸患儿。如果采用早期手术加 3 个月疗程的适当抗菌药物治疗，大多数患儿可能可以保留植入物并治愈。
