title: A retrospective identification of gastroesophageal reflux disease as a new risk factor for surgical site infection in cerebral palsy patients after spine surgery.
abstract: BACKGROUND
  Neuromuscular scoliosis is a known risk factor for surgical site infection (SSI) after spinal fusion, with reported infection rates as high as 11.2%. Although risk factors such as antibiotic timing have been previously addressed, our objective was to identify intrinsic risk factors for SSI in cerebral palsy (CP) patients with neuromuscular scoliosis. We hypothesized that CP patients who develop SSI after spine fusion would have a risk profile similar to those who develop nosocomial infection.
  
  
  METHODS
  We retrospectively analyzed records from patients with CP who developed infections after spinal fusion from January 1998 until July 2008, who were identified by our Infection Control Officer using National Nosocomial Infection Surveillance System criteria (N = 34). Demographically and procedurally matched controls without infection were identified from our spine database (N = 37). We compared these groups for gastroesophageal reflux disease (GERD), use of gastric acid inhibitors, presence of preoperative decubitus ulcer, previous infection, and postoperative ventilation. Multivariable logistic regression was then performed to assess the relative contributions of the predictors to "deep infection" and "any infection."
  
  
  RESULTS
  Of 30 evaluable infected patients, 70% had incisional SSI. Although many of the infections were polymicrobial, the most common pathogens identified were Gram-negative bacilli. Many significant predictors were identified by univariable logistic regression for any infection and deep infection. Multivariable logistic regression found a significant effect only for GERD (odds ratio, 6.4; 95% confidence interval, 1.9-21.3; P = 0.002) for any infection, whereas the effect of therapy with gastric acid inhibitors did not reach statistical significance (odds ratio, 6.1 [95% confidence interval, 0.84-44.6]; P = 0.07). No significant interaction between the 2 factors was detected. Among our controls and infected patients altogether, 46.3% had GERD.
  
  
  CONCLUSIONS
  We show that GERD increases the risk for infection in CP patients after spine fusion. Prospective multicenter studies are necessary to further validate the predictive value of this risk factor.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, the Charlotte R. Bloomberg Children's Center, Johns Hopkins University, 800 Orleans St., Room 6349D, Baltimore, MD 21287, USA.
authors.forename: Vidya
authors.initials: V
authors.lastname: Chidambaran
authors.forename: Carol
authors.initials: C
authors.lastname: Gentry
authors.forename: Chinwe
authors.initials: C
authors.lastname: Ajuba-Iwuji
authors.forename: Paul D
authors.initials: PD
authors.lastname: Sponsellar
authors.forename: Michael
authors.initials: M
authors.lastname: Ain
authors.forename: Elaina
authors.initials: E
authors.lastname: Lin
authors.forename: Xue
authors.initials: X
authors.lastname: Zhang
authors.forename: Sybil Ann
authors.initials: SA
authors.lastname: Klaus
authors.forename: Dolores B
authors.initials: DB
authors.lastname: Njoku
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000453:epidemiology* / Q000601:surgery*; D002648:Child; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology*