Deep wound infections after spinal fusion in children with cerebral palsy: A prospective cohort study

Paul D. Sponseller, Amit Jain, Suken A. Shah, Amer Samdani, Burt Yaszay, Peter O. Newton, Leslie Marie Thaxton, Tracey P. Bastrom, Michelle C. Marks

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)2023-2027
Number of pages5
JournalSpine
Volume38
Issue number23
DOIs
StatePublished - Nov 1 2013

Keywords

  • cerebral palsy
  • infection
  • neuromuscular
  • risk factors
  • spine deformity

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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