The management and outcome of spinal implant-related infections in pediatric patients: a retrospective review.
BACKGROUND
Infection after implantation of spinal rods is a significant complication of this procedure. Optimal treatment of surgical implants often involves device removal. This approach is problematic when treating spinal implant-related infections, because device removal may cause significant morbidity. Medical management of these infections is therefore necessary, but treatment regimens are not standardized. We conducted a retrospective review of pediatric patients with spinal implant-related infections at a regional spinal center for a 6-year period. We describe clinical course, duration of treatment and outcomes.


METHODS
We reviewed records of patients with spinal implant-related infections from 2005 to 2010. Data collection included demographics, underlying diagnosis, surgical hardware, timing to infection after implantation, signs and symptoms of infection, duration of antimicrobials, adverse drug events and long-term outcomes.


RESULTS
We enrolled 23 patients with spinal implant infections, aged 8-20 years. Wound drainage was the most common presenting symptom (82.6%). Median time from surgery to first infection was 16 days (range: 8-1052 days). Median length of antimicrobial therapy was 131 days (range: 42-597 days). Seventy eight percent were cured with antibiotics alone with implanted devices retained. Four patients failed medical therapy and required device removal. A wide range of antibiotic duration was used (42 to >597 days). Seven patients (30.4%) experienced at least 1 adverse drug event.


CONCLUSIONS
Infection related to spinal instrumentation procedures can be managed medically with long-term antibiotic therapy. Careful monitoring for not only efficacy but also adverse drug events is advised. Further research is needed to determine the optimal duration of antibiotics for spinal implant-related infections.
From the *Department of Pediatrics, Division of Infectious Diseases, All Children's Hospital, Saint Petersburg, FL; †Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD; and ‡Department of Surgery, All Children's Hospital, Saint Petersburg, FL.
Allison F
AF
Messina
David M
DM
Berman
Sharon R
SR
Ghazarian
Ravi
R
Patel
Jeffrey
J
Neustadt
Gregory
G
Hahn
Erica M S
EM
Sibinga
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D008297:Male; D016459:Prosthesis-Related Infections / Q000601:surgery* / Q000628:therapy*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents