295. Spinal Instrumentation infections in Children and Adolescents
Session: Poster Abstract Session: HAIs in Children
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 41427# IDW2013 poster .pdf (362.0 kB)
  • Background:   Spinal instrumentation infections in children and adolescents pose a unique challenge to the infectious disease clinician and the surgeon. Since 2010, as part of a statewide collaborative, strategies to prevent these infections have been adopted, but even with excellent compliance with these measures, these infections continue to occur although we have experienced a significant decline. Our aim is to describe the clinical and microbiological characteristics of children treated for spinal instrumentation infections at the infectious disease clinic at our institution.

    Methods:  Charts of children presenting with spinal instrumentation infections that were treated by pediatric infectious disease specialist at our institution between the 01- 2005 and 12-2011 were retrospectively reviewed for clinical and microbiology data.

    Results:  Forty five children with spinal instrumentation infection were identified out of 786 spine procedures performed during the study period. Fifty-five per cent were male and 44% of all children had cerebral palsy. Seventeen had early  infections, defined as infections within 30 days of the instrumentation. Median time from instrumentation to infection was 14 days for early  infections and > 1 year for late infections.  Fever and wound drainage/dehiscence were the most common clinical presentation for early and late infections. The CRP was higher in patients with early infections (median 20.2 mg/dl for early   and 8.85 mg/dl in the late infections) .Sixty-five percent of early infections were mono-microbial and methicillin susceptible S. aureus (MSSA) was the most commonly isolated organism (59%). In contrast, 65% of late  infections were poly-microbial however; MSSA was isolated in 79% of these patients. Pseudomonas aeruginosa was the most common gram negative isolated from early and late infections. (17 and 14% respectively).

    Conclusion:  Methicillin susceptible S. aureus was the most common organism isolated from our patients with early and late onset instrumentation infections. Based on this data, cefazolin continues to be the preferred empiric prophylactic peri-operative antibiotic for spinal instrumentation surgeries at our institution. Efforts continue to optimize our bundles as we pursue our goal of zero infections.

    Beth D'amico, M.D1, Connie Poe-Kochert, N.P2, Mary Ann O'riordan, Ph.D3, Susan Conte, R.N4, George H Thompson, M.D2 and Blanca E Gonzalez, M.D5, (1)Pediatric Emergency Medicine, Baylor College of Medicine, Houston, TX, (2)Pediatric Orthopedics, University Hospitals Case Medical Center, Cleveland, OH, (3)Case Western Reserve University, Cleveland, OH, (4)Infection Control and Prevention, University Hospitals Case Medical Center, Cleveland, OH, (5)Pediatric Infectious Diseases, Lerner School of Medicine of Case Western Reserve University, Cleveland, OH

    Disclosures:

    B. D'amico, None

    C. Poe-Kochert, None

    M. A. O'riordan, None

    S. Conte, None

    G. H. Thompson, None

    B. E. Gonzalez, None

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