title: Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.
abstract: METHODS
  A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed.
  
  
  OBJECTIVE
  To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment.
  
  
  BACKGROUND
  No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients.
  
  
  METHODS
  After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal.
  
  
  RESULTS
  Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative Staphylococcus, Enterobacter, Enterococcus, and Escherichia coli.- Debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012).
  
  
  CONCLUSIONS
  Patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. Patients in whom infection develops are then at increased risk for pseudarthrosis.
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0882, USA. psponse@.jhmi.edu
authors.forename: P D
authors.initials: PD
authors.lastname: Sponseller
authors.forename: D M
authors.initials: DM
authors.lastname: LaPorte
authors.forename: M W
authors.initials: MW
authors.lastname: Hungerford
authors.forename: K
authors.initials: K
authors.lastname: Eck
authors.forename: K H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: L G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D004322:Drainage; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D019637:Orthopedic Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents