Surgical Site Infections Following Pediatric Spine Fusion Procedures, Based on Type of Perioperative Antibiotic Prophylaxis
Objective:To retrospectively explore whether use of vancomycin or clindamycin rather than cefazolin was associated with a higher incidence of SSIs following pediatric spine fusion.
Methods: Risk factors for deep SSIs were explored in Cleveland Clinic patients < 18 years undergoing spine surgery between 2006 and 2013. Data was retrieved using a CPT code based algorithm. SSI definitions were as per the National Healthcare Safety Network. Fischer’s exact test was used for statistical analyses.
Results: SSIs developed in 4.4% (27 of 608) of children. For cefazolin the rate was 3.9% (20 of 513) compared to 11.5% for vancomycin (3 of 26; P 0.09) and 23.5% for clindamycin (4 of 17; P 0.005). The rate for cefazolin plus vancomycin or clindamycin was 0% (0 of 43), which was significantly lower than for vancomycin or clindamycin (P 0.01), but not for cefazolin (P 0.39). Among patients treated with clindamycin vs cefazolin, the rate of both early (11.8% vs 1.9%; P 0.05) and late onset (11.8% vs 1.9%; P 0.05) infection was higher; vancomycin use was associated with a higher rate of early (11.5%; 0.05) infection. Clindamycin use was a risk factor for P. acne SSI (3 of 510 vs 3 of 17; P 0.0004). The penicillin allergy rate was 6.2% for cefazolin, 38.5% for vancomycin (P <0.0001) and 88.2% for clindamycin (<0.0001). The screening rate for S. aureus colonization was 21.1% for cefazolin, 38.5% for vancomycin (P 0.05), and 17.6% for clindamycin. None of the 4 MRSA colonized patients developed an SSI: 3 treated with cefazolin and one with vancomycin.
Conclusion: Monotherapy with vancomycin or clindamycin was used in only 7.1% of the pediatric spine fusion cases, but this small group accounted for 25.9% of our SSIs. Compared to cefazolin, this translates to a 319% increased SSI rate. Efforts need to be directed at identifying those patients who require pre-operative allergy evaluation and at promoting the use of cefazolin for those patients who do not have a true contraindication to cephalosporin use. When surgical prophylaxis with vancomycin or clindamycin is indicated, combination therapy with cefazolin should be strongly considered.
G. Gagliano, None
R. Goodwin, None
D. Gurd, None
T. Kuivila, None
V. Arakoni, None
C. B. Foster, None