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Surgical-Site Infection Following Spinal Fusion: A Case-Control Study in a Children's Hospital

Published online by Cambridge University Press:  02 January 2015

Annie-Claude Labbé ,
Anne-Marie Demers ,
Ramona Rodrigues ,
Vincent Arlet ,
Kim Tanguay  and
Dorothy L. Moore
Annie-Claude Labbé
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Anne-Marie Demers
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Ramona Rodrigues
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Vincent Arlet
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Kim Tanguay
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Dorothy L. Moore*
Affiliation:
Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
*
Montreal Children's Hospital, Room C1242, 2300 Tupper Street, Montreal, Quebec, Canada H3H 1P3
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Abstract

Objectives:

To determine the rates of surgical-site infections (SSIs) after spinal surgery and to identify the risk factors associated with infection.

Design:

SSIs had been identified by active prospective surveillance. A case-control study to identify risk factors was performed retrospectively.

Setting:

University-associated, tertiary-care pediatric hospital.

Patients:

All patients who underwent spinal surgery between 1994 and 1998. Cases were all patients who developed an SSI after spinal surgery. Controls were patients who did not develop an SSI, matched with the cases for the presence or absence of myelodysplasia and for the surgery date closest to that of the case.

Results:

There were 10 infections following 125 posterior spinal fusions, 4 infections after 50 combined anterior-posterior fusions, and none after 95 other operations. The infection rate was higher in patients with myelodysplasia (32 per 100 operations) than in other patients (3.4 per 100 operations; relative risk = 9.45; P < .001). Gram-negative organisms were more common in early infections and Staphylococcus aureus in later infections. Most infections occurred in fusion involving sacral vertebrae (odds ratio [OR] = 12.0; P = .019). Antibiotic prophylaxis was more frequently suboptimal in cases than in controls (OR = 5.5; P = .034). Five patients required removal of instrumentation and 4 others required surgical debridement.

Conclusions:

Patients with myelodysplasia are at a higher risk for SSIs after spinal fusion. Optimal antibiotic prophylaxis may reduce the risk of infection, especially in high-risk patients such as those with myelodysplasia or those undergoing fusion involving the sacral area.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 8 , August 2003 , pp. 591 - 595
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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