title: Deep wound infections after spinal fusion in children with cerebral palsy: a prospective cohort study.
abstract: METHODS
  Prospective cohort.
  
  
  OBJECTIVE
  To (1) calculate the rate of deep wound infection in children with cerebral palsy (CP) after spinal fusion surgery; (2) identify factors (patient, laboratory, and surgical) associated with deep wound infection development; and (3) report causative organisms.
  
  
  BACKGROUND
  Wound infection after spine fusion for CP is more common than after spine fusion for most other diagnoses.
  
  
  METHODS
  We prospectively gathered data on 204 consecutive pediatric patients with CP who underwent surgery at 7 institutions. Univariate and multivariate regression analysis was performed to analyze patient, laboratory, and surgical characteristics to identify factors that were significantly associated with infection development. Statistical significance was set at a value of P less than 0.05.
  
  
  RESULTS
  Deep wound infection developed in 13 (6.4%) children. The mean time to infection development was 34.2 ± 60.2 days. On univariate analysis, older age, larger curve size, presence of gastrostomy/gastrojejunostomy tube, higher preoperative serum white blood cell count, and longer operative time were significantly associated with deep wound infection. On multivariate analysis, only the presence of a gastrostomy/gastrojejunostomy tube remained significant (1.9-fold risk of deep wound infection compared with patients without tubes). Escherichia coli was the most common organism cultured from the wound sites (5 patients). Other infective agents were: Pseudomonas aeruginosa (2), methicillin-susceptible Staphylococcus aureus (1), Proteus mirabilis (1), and polymicrobial organisms (4).
  
  
  CONCLUSIONS
  Deep wound infection occurred in 6.4% of children with CP after spinal fusion. The presence of a gastrostomy/gastrojejunostomy tube was a significant predictor of infection. Gram-negative organisms were the most common causative agents. Surgeons should be cognizant of these factors when treating children with CP and may consider Gram-negative antibiotic prophylaxis.
authors: *Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD †Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE ‡Shriner's Hospital, Philadelphia, PA; and §Department of Orthopedics, Rady Children's Hospital of San Diego, CA.
authors: Paul D
authors: PD
authors: Sponseller
authors: Amit
authors: A
authors: Jain
authors: Suken A
authors: SA
authors: Shah
authors: Amer
authors: A
authors: Samdani
authors: Burt
authors: B
authors: Yaszay
authors: Peter O
authors: PO
authors: Newton
authors: Leslie-Marie
authors: LM
authors: Thaxton
authors: Tracey P
authors: TP
authors: Bastrom
authors: Michelle C
authors: MC
authors: Marks
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D015390:Gastric Bypass / Q000009:adverse effects / Q000295:instrumentation; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects*; D013131:Spine / Q000002:abnormalities / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D013997:Time Factors; D014481:United States