High prevalence of gram-negative and multiorganism surgical site infections after pediatric complex tethered spinal cord surgery: a multicenter study

Nikita G. AlexiadesDepartment of Neurosurgery, University of Arizona–Phoenix, Arizona;

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Belinda ShaoDepartment of Neurosurgery, Brown University, Providence, Rhode Island;

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Edward S. AhnDepartment of Neurosurgery, Mayo Clinic, Rochester, Minnesota;

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Jeffrey P. BlountDivision of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama;

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Douglas L. BrockmeyerDepartment of Pediatric Neurosurgery, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah;

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Todd C. HankinsonDepartment of Pediatric Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado;

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Cody L. NesvickDepartment of Neurosurgery, Mayo Clinic, Rochester, Minnesota;

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David I. SandbergDivision of Pediatric Neurosurgery, McGovern Medical School/UT Health/Children’s Memorial Hermann Hospital, Houston, Texas;

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Gregory G. HeuerDepartment of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania;

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Lisa SaimanDepartment of Pediatric Infectious Disease, Columbia University Medical Center, New York, New York;

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Neil A. FeldsteinDepartment of Neurological Surgery, Columbia University Medical Center, New York, New York; and

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Richard C. E. AndersonDepartment of Neurosurgery, New York University, New York, New York

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OBJECTIVE

Complex tethered spinal cord (cTSC) release in children is often complicated by surgical site infection (SSI). Children undergoing this surgery share many similarities with patients undergoing correction for neuromuscular scoliosis, where high rates of gram-negative and polymicrobial infections have been reported. Similar organisms isolated from SSIs after cTSC release were recently demonstrated in a single-center pilot study. The purpose of this investigation was to determine if these findings are reproducible across a larger, multicenter study.

METHODS

A multicenter, retrospective chart review including 7 centers was conducted to identify all cases of SSI following cTSC release during a 10-year study period from 2007 to 2017. Demographic information along with specific microbial culture data and antibiotic sensitivities for each cultured organism were collected.

RESULTS

A total of 44 SSIs were identified from a total of 655 cases, with 78 individual organisms isolated. There was an overall SSI rate of 6.7%, with 43% polymicrobial and 66% containing at least one gram-negative organism. Half of SSIs included an organism that was resistant to cefazolin, whereas only 32% of SSIs were completely susceptible to cefazolin.

CONCLUSIONS

In this study, gram-negative and polymicrobial infections were responsible for the majority of SSIs following cTSC surgery, with approximately half resistant to cefazolin. Broader gram-negative antibiotic prophylaxis should be considered for this patient population.

ABBREVIATIONS

cTSC = complex TSC; GI = gastrointestinal; GU = genitourinary; SSI = surgical site infection; TSC = tethered spinal cord.
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Illustration from Cinalli et al. (pp 330–341). Printed with permission from © CC Medical Arts.

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