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Postoperative Spinal Implant Infections in Children: Risk Factors, Characteristics, and Outcome

Lamberet, Aurore MD; Violas, Philippe MD, PhD; Buffet-Bataillon, Sylvie MD; Hamel, Antoine MD, PhD; Launay, Elise MD; Lamberet, Romain MD; Arvieux, Cédric MD; Tattevin, Pierre MD, PhD
The Pediatric Infectious Disease Journal: Post Acceptance: October 30, 2017
doi: 10.1097/INF.0000000000001812
Original Studies: PDF Only

Background:

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.

Methods:

We performed a retrospective observational study of all children who underwent posterior spinal fusion with instrumentation in two 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 (i.e. within 30 days). Data were collected on a standardized questionnaire from medical charts.

Results:

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 post-surgery [IQR, 7-18]. Postoperative infection was more common in children with neurologic scoliosis as compared with idiopathic scoliosis (12.2% (15/123) vs 2.4% (5/211); P<0.01). Neurologic scoliosis was an independent predictor of spinal implant infections (HR 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, lavage), and antibiotics for a median duration of 19 weeks [IQR, 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.

Conclusion:

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-months course of appropriate antibacterial agents.

No funding was received for this study

Conflict of interest : none

Correspondence and reprints: Prof. Pierre Tattevin, Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, rue Le Guilloux, 35033 Rennes Cedex, France. Tel +33 299289564. Fax +33 299282452 E-mail address:pierre.tattevin@chu-rennes.fr

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