Prevention of surgical site infections in pediatric spines: a single-center experience

Solla, Federico; Lefèbvre, Romain; Clément, Jean-Luc; Lévy, Yoann; Oborocianu, Ioana; Rampal, Virginie; Bertoncelli, Carlo M.

doi:10.1007/s00381-021-05095-x

Cited by 8 publications

(9 citation statements)

References 22 publications

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“…Of note, their study population underwent procedures before BPG publication; however, the significant decrease in SSIs emphasizes the importance of a standard antibiotic prophylaxis protocol with components highlighted by the BPGs. Other studies have shown similar decreases in SSI rates after the implementation of institution-specific antibiotic prophylaxis policies incorporating cefazolin, aminoglycosides, and topical vancomycin powder 24,25. In our study, SSI rates were lower following BPG publication and approached statistical significance; however, our study was likely underpowered for this analysis.…”

Section: Discussionsupporting

confidence: 41%

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Faust

Allahabadi

Louer

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Best Practice Guidelines (BPGs) regarding antibiotic prophylaxis in early-onset scoliosis (EOS) patients were published in September 2019. Recommendations included using intravenous cefazolin and topical vancomycin for all index procedures, plus gram-negative coverage for neuromuscular patients. Guideline adherence is unknown. This study aimed to characterize antibiotic prophylaxis at the time of index growth-friendly procedures and assess changes in practice patterns over time. Materials and Methods: This retrospective review of data collected through a multicenter study group included EOS patients undergoing index growth-friendly procedures between January 2018 and March 2021, excluding revisions, lengthenings, and tetherings. Demographics, clinical measurements, intraoperative antibiotics, and 90-day complications were recorded. Descriptive and univariate statistics were utilized. Antibiotic prophylaxis from April 2018 through September 2019 and October 2019 through March 2021 were compared with evaluate change after BPG publication. Results: A total of 562 patients undergoing growth-friendly procedures were included. The most common scoliosis types included neuromuscular (167, 29.7%), syndromic (134, 23.8%), and congenital (97, 17.3%). Most index procedures involved magnetically controlled growing rods (417, 74%) followed by vertical expandable prosthetic titanium rib or traditional growing rods (105, 19%). Most patients received cefazolin alone at index procedure (310, 55.2%) or cefazolin with an aminoglycoside (113, 20.1%). Topical antibiotics were used in 327 patients (58.2%), with most receiving vancomycin powder. There was increased use of cefazolin with an aminoglycoside after BPG publication (16% vs. 25%) (P = 0.01). Surgical site infections occurred in 12 patients (2.1%) within 90 days of index procedure, 10 pre-BPGs (3%), and 2 post-BPGs (0.9%), with no significant difference in surgical site infection rate by type of antibiotic administered (P > 0.05). Conclusions: Historical variability exists regarding antibiotic prophylaxis during index growth-friendly procedures for EOS. There continues to be variability following BPG publication; however, this study found a significant increase in antibiotic prophylaxis against gram-negative bacteria after BPG publication. Overall, greater emphasis is needed to decrease variability in practice, improve compliance with consensus guidelines, and evaluate BPG efficacy. Level of Evidence: Level III-retrospective.

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Section: Discussionsupporting

confidence: 41%

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Faust

Allahabadi

Louer

et al. 2023

Journal of Pediatric Orthopaedics

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“…Two Level III studies reported that adoption of strategies outlined in the 2013 Best Practice Guidelines by Vitale et al 11 led to significant decreases in the incidence of SSI 75,76 . Other Level III studies have reported promising results after implementation of institution-specific protocols which similarly combine multiple evidence-based prevention practices, although these protocols were variable 66,77–79 …”

Section: Resultsmentioning

confidence: 99%

“…75,76 Other Level III studies have reported promising results after implementation of institution-specific protocols which similarly combine multiple evidence-based prevention practices, although these protocols were variable. 66,[77][78][79] Conclusions: There is grade B evidence that bundled SSI prevention protocols are effective at lowering the incidence of SSI after scoliosis surgery in pediatric populations.…”

Section: Implementation Of Bundled Ssi Prevention Protocolsmentioning

confidence: 99%

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

Gupta

Badin

Leland

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Surgical site infection (SSI) is a major potential complication following pediatric spinal deformity surgery that is associated with significant morbidity and increased costs. Despite this, SSI rates remain high and variable across institutions, in part due to a lack of up-to-date, comprehensive prevention, and treatment protocols. Furthermore, few attempts have been made to review the optimal diagnostic modalities and treatment strategies for SSI following scoliosis surgery. The aim of this study was to systematically review current literature on risk factors for SSI in pediatric patients undergoing scoliosis surgery, as well as strategies for prevention, diagnosis, and treatment. Methods: On January 19, 2022, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting risk factors for acute, deep SSI (<90 d) or strategies for prevention, diagnosis, or treatment of SSI following pediatric scoliosis surgery were included. Each included article was assigned a level of evidence rating based on study design and quality. Extracted findings were organized into risk factors, preventive strategies, diagnostic modalities, and treatment options and each piece of evidence was graded based on quality, quantity, and consistency of underlying data. Results: A total of 77 studies met the inclusion criteria and were included in this systematic review, of which 2 were categorized as Level I, 3 as Level II, 64 as Level III, and 8 as Level IV. From these studies, a total of 29 pieces of evidence (grade C or higher) regarding SSI risk factors, prevention, diagnosis, or treatment were synthesized. Conclusions: We present an updated review of published evidence for defining high-risk patients and preventing, diagnosing, and treating SSI after pediatric scoliosis surgery. The collated evidence presented herein may help limit variability in practice and decrease the incidence of SSI in pediatric spine surgery. Level of Evidence: Level III—systematic review.

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“…In case of colonization by MRSA or MSSA, or if the patient cannot wait 5 days for decolonization pre-surgery, vancomycin in addition to cefazolin is recommended for SAP [ 29 ]. Due to the pharmacokinetics of vancomycin, it is recommended to end its infusion 60 min before skin cut to allow vancomycin to reach optimal drug distribution in blood and tissue [ 30 ]. Moreover, vancomycin infusion should not be too fast and should last 30–60 min to prevent red men syndrome and other side effects [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

et al. 2022

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Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.

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Prevention of surgical site infections in pediatric spines: a single-center experience

Cited by 8 publications

References 22 publications

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Intraoperative Antibiotic Use in Patients With Early-onset Scoliosis: Current Practices and Trends

Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery

Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study

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