1. Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study.
- Author
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Sponseller PD, Jain A, Shah SA, Samdani A, Yaszay B, Newton PO, Thaxton LM, Bastrom TP, and Marks MC
- Subjects
- Adolescent, Age Factors, Child, Gastric Bypass adverse effects, Gastric Bypass instrumentation, Gastrostomy adverse effects, Gastrostomy instrumentation, Humans, Leukocyte Count, Logistic Models, Multivariate Analysis, Prospective Studies, Risk Factors, Spine abnormalities, Surgical Wound Infection diagnosis, Surgical Wound Infection microbiology, Time Factors, United States, Cerebral Palsy complications, Spinal Fusion adverse effects, Spine surgery, Surgical Wound Infection etiology
- 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.
- Published
- 2013
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