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 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.
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.
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:firstname.lastname@example.org
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