Infections in children and young adults with bone malignancies undergoing limb-sparing surgery.
BACKGROUND
The epidemiology, risk factors, and efficacy of therapy for infections complicating limb-sparing surgery (LSS) are not understood completely.


METHODS
The authors conducted a retrospective review of children and adolescents with bone malignancies who underwent LSS.


RESULTS
One hundred three patients underwent 104 LSS procedures. Patients experienced a median of 4 infections (range, 0-13 infections), including focal bacterial infections in 67% of patients and bacteremia in 21% of patients. Infections at the LSS site occurred in 26% of patients, and 21% of patients developed orthopedic device infections (ODIs). Compared with patients without ODIs, patients who developed ODIs were more likely to be African American and to have wound infections, and they were less likely to have tumors of the femur than the tibia. In a multivariate analysis, only African-American race and local infection at the LSS site retained a significant association with ODIs. Among survivors, patients who developed ODIs were more likely to undergo amputation (odds ratio [OR], 24.0; 95% confidence interval [95%CI], 5.1-114.0; P < 0.001) and were less likely to have good functional outcomes (OR, 0.02; 95%CI, 0.002-0.15; P < 0.001) compared with patients who did not have an ODI. Overall, only 1 of 22 patients with an ODI was treated successfully without removal of the orthopedic device or amputation.


CONCLUSIONS
Current treatment for bone malignancies is complicated by an unexpectedly high incidence of infection. ODI was the most common reason for amputation and poor functional outcomes. The identification of risk factors for ODI may allow modifications of therapy that reduce the incidence and severity of infection, but prevention of all ODIs will require novel strategies.
Gaur
Aditya H
AH
Department of Infectious Diseases, St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, TN 38105, USA.
Liu
Tiebin
T
Knapp
Katherine M
KM
Daw
Najat C
NC
Rao
Bhaskar N
BN
Neel
Michael D
MD
Rodriguez-Galindo
Carlos
C
Brand
Diane
D
Adderson
Elisabeth E
EE
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D001859:Bone Neoplasms / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D023821:Limb Salvage; D008297:Male; D009984:Orthopedic Fixation Devices / Q000009:adverse effects*; D009985:Orthopedics; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy; D015996:Survival Rate
D000900:Anti-Bacterial Agents