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

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  • 1 Department of Neurosurgery, University of Arizona–Phoenix, Arizona;
  • | 2 Department of Neurosurgery, Brown University, Providence, Rhode Island;
  • | 3 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
  • | 4 Division of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama;
  • | 5 Department of Pediatric Neurosurgery, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah;
  • | 6 Department of Pediatric Neurosurgery, Children’s Hospital Colorado, Aurora, Colorado;
  • | 7 Division of Pediatric Neurosurgery, McGovern Medical School/UT Health/Children’s Memorial Hermann Hospital, Houston, Texas;
  • | 8 Department of Neurosurgery, Children’s Hospital of Philadelphia, Pennsylvania;
  • | 9 Department of Pediatric Infectious Disease, Columbia University Medical Center, New York, New York;
  • | 10 Department of Neurological Surgery, Columbia University Medical Center, New York, New York; and
  • | 11 Department 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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  • 1

    Mehta VA, Bettegowda C, Ahmadi SA, et al. Spinal cord tethering following myelomeningocele repair. J Neurosurg Pediatr. 2010;6(5):498505.

  • 2

    Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181187.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Chern JJ, Tubbs RS, Patel AJ, et al. Preventing cerebrospinal fluid leak following transection of a tight filum terminale. J Neurosurg Pediatr. 2011;8(1):3538.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Pang D, Zovickian J, Oviedo A. Long-term outcome of total and near-total resection of spinal cord lipomas and radical reconstruction of the neural placode, part II: outcome analysis and preoperative profiling. Neurosurgery. 2010;66(2):253273.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Vitale MG, Riedel MD, Glotzbecker MP, et al. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery. J Pediatr Orthop. 2013;33(5):471478.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Vitale MG, Mackenzie SW, Matsumoto H, et al. Surgical site infection following spinal instrumentation for scoliosis: lessons learned from an multi-center analysis of 1352 spinal instrumentation procedures for scoliosis. Paper 32. In: Spine: Affiliated Society Meeting Abstracts. Lippincott; 2011:71.

    • Search Google Scholar
    • Export Citation
  • 7

    Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195283.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Lietard C, Thébaud V, Besson G, Lejeune B. Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg. 2008;109(4):729734.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Alexiades NG, Shao B, Saiman L, Feldstein N, Anderson RCE. High prevalence of gram-negative rod and multi-organism surgical site infections after pediatric complex tethered spinal cord surgery: preliminary report from a single-center study. Pediatr Neurosurg. 2020;55(2):92100.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(suppl 2):S66S88.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Thuy M, Chaseling R, Fowler A. Spinal cord detethering procedures in children: a 5 year retrospective cohort study of the early post-operative course. J Clin Neurosci. 2015;22(5):838842.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Guerra LA, Pike J, Milks J, Barrowman N, Leonard M. Outcome in patients who underwent tethered cord release for occult spinal dysraphism. J Urol. 2006;176(4 Pt 2):17291732.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Geyik M, Alptekin M, Erkutlu I, et al. Tethered cord syndrome in children: a single-center experience with 162 patients. Childs Nerv Syst. 2015;31(9):15591563.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Bowman RM, Mohan A, Ito J, Seibly JM, McLone DG. Tethered cord release: a long-term study in 114 patients. J Neurosurg Pediatr. 2009;3(3):181187.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Sherrod BA, Arynchyna AA, Johnston JM, et al. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience. J Neurosurg Pediatr. 2017;19(4):407420.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Alexiades NG, Ahn ES, Blount JP, et al. Development of best practices to minimize wound complications after complex tethered spinal cord surgery: a modified Delphi study. J Neurosurg Pediatr. 2018;22(6):701709.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Sponseller PD, LaPorte DM, Hungerford MW, Eck K, Bridwell KH, Lenke LG. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes. Spine (Phila Pa 1976). 2000;25(19):24612466.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Hatlen T, Song K, Shurtleff D, Duguay S. Contributory factors to postoperative spinal fusion complications for children with myelomeningocele. Spine (Phila Pa 1976). 2010;35(13):12941299.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Clinical Laboratory Standards Institute. M100: Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Clinical and Laboratory Standards Institute; 2020.

    • Search Google Scholar
    • Export Citation
  • 20

    GlaxoSmithKline. Ancef (cefazolin) [package insert]. GlaxoSmithKline; 2004.

  • 21

    Meyrat BJ, Tercier S, Lutz N, Rilliet B, Forcada-Guex M, Vernet O. Introduction of a urodynamic score to detect pre- and postoperative neurological deficits in children with a primary tethered cord. Childs Nerv Syst. 2003;19(10-11):716721.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Nogueira M, Greenfield SP, Wan J, Santana A, Li V. Tethered cord in children: a clinical classification with urodynamic correlation. J Urol. 2004;172(4 Pt 2):16771680.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Rendeli C, Ausili E, Tabacco F, et al. Urodynamic evaluation in children with lipomeningocele: timing for neurosurgery, spinal cord tethering and followup. J Urol. 2007;177(6):23192324.

    • Crossref
    • Search Google Scholar
    • Export Citation

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