Wei Jou, Brown Conrad, Moore Tomas, Graham Nicolette, Davis Mathew, Gatehouse Simon, Nourse Clare
From the Queensland Children's Hospital.
Graduate Medical School, University of Queensland.
Pediatr Infect Dis J. 2024 Apr 1;43(4):333-338. doi: 10.1097/INF.0000000000004218. Epub 2023 Dec 14.
Postoperative spinal implant infection following pediatric spinal surgery often presents a management dilemma. We aimed to characterize our experience in this cohort of patients, hoping to provide further insight when approaching these challenging cases.
A retrospective, observational study was performed of all children who underwent spinal surgery from January 2015 to June 2021 in a tertiary pediatric spinal surgery referral center in Queensland, Australia. Records were reviewed to identify cases of postoperative surgical site infection, with particular focus on children with infection directly involving implants. Preoperative prophylaxis, microbiology, clinical course and outcomes were analyzed.
A total of 580 children underwent 933 procedures during the study period. The most common pathology requiring surgery was idiopathic scoliosis in 257 children (44.3%) followed by neuromuscular scoliosis in 192 children (33.1%). There were 35 cases of surgical site infection (6.03%), and 9 were implant-associated (1.55%). Infection rate among children with neuromuscular spinal deformity was almost 3-fold higher (11.5%) than idiopathic (3.89%). Methicillin-sensitive Staphylococcus aureus was the most commonly isolated organism (n = 15). Four implant-associated infections were successfully managed with retention of implant; all were diagnosed within 32 days (median = 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa . Conversely, infections that necessitated implant removal had a more indolent onset (median = 175 days), and more often cultured Cutibacterium acnes and coagulase-negative Staphylococci .
Postoperative spinal implant infection can be treated successfully with hardware retention in select cases. Earlier presentation and recognition appear to be associated with better rates of retention and are linked to certain organisms. Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections.
小儿脊柱手术后的脊柱植入物感染常常带来治疗难题。我们旨在描述我们在这组患者中的经验，希望在处理这些具有挑战性的病例时能提供更多见解。
对2015年1月至2021年6月在澳大利亚昆士兰州一家三级小儿脊柱手术转诊中心接受脊柱手术的所有儿童进行了一项回顾性观察研究。查阅记录以确定术后手术部位感染的病例，特别关注直接涉及植入物的感染儿童。分析了术前预防措施、微生物学、临床过程和结果。
在研究期间，共有580名儿童接受了933例手术。需要手术的最常见病理情况是257名儿童（44.3%）的特发性脊柱侧弯，其次是192名儿童（33.1%）的神经肌肉性脊柱侧弯。有35例手术部位感染（6.03%），其中9例与植入物相关（1.55%）。神经肌肉性脊柱畸形儿童的感染率几乎比特发性脊柱侧弯儿童高3倍（11.5%对比3.89%）。甲氧西林敏感金黄色葡萄球菌是最常分离出的病原体（n = 15）。4例与植入物相关的感染通过保留植入物成功治疗；所有感染均在32天内确诊（中位数 = 20天），培养出的病原体为金黄色葡萄球菌或铜绿假单胞菌。相反，需要取出植入物的感染起病更为隐匿（中位数 = 175天），更常培养出痤疮丙酸杆菌和凝固酶阴性葡萄球菌。
在某些情况下，术后脊柱植入物感染可通过保留硬件成功治疗。早期出现和识别似乎与更高的保留率相关，并且与某些病原体有关。进一步探索特定的预防策略可能是预防毁灭性迟发性感染的关键。
