• Paul D Sponseller, Amit Jain, Suken A Shah, Amer Samdani, Burt Yaszay, Peter O Newton, Leslie-Marie Thaxton, Tracey P Bastrom, and Michelle C Marks.
• *Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE ‡Shriner's Hospital, Philadelphia, PA; and §Department of Orthopedics, Rady Children's Hospital of San Diego, CA.
• Spine. 2013 Nov 1;38(23):2023-7.

Study DesignProspective cohort.ObjectiveTo (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 DataWound infection after spine fusion for CP is more common than after spine fusion for most other diagnoses.MethodsWe 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.ResultsDeep 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).ConclusionDeep 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.

28 keywords...

hide…