A Multicenter Study of the Epidemiology of Deep Surgical Site Infections in Children With Nonidiopathic Early-Onset Scoliosis Including Associated Pathogens

Spine Deform. 2019 Jul;7(4):647-651. doi: 10.1016/j.jspd.2018.11.015.


Study design: Retrospective descriptive.

Objectives: Identify incidence and risk of deep surgical site infections (SSIs), associated pathogens, and antibiotic susceptibility in patients with nonidiopathic early-onset scoliosis (EOS) undergoing growth-friendly (GF) spine surgery.

Background: SSIs following GF procedures for EOS are well described, but epidemiologic trends in associated pathogens have not been well characterized.

Methods: The Children's Spine Study Group database was queried for children ≤18 years of age undergoing GF procedures for nonidiopathic EOS at 11 institutions from September 2001 to January 2016. Deep SSIs reported within 90 days of procedures were reviewed for associated pathogens and their susceptibility profiles. Data were analyzed to calculate incidence and risk.

Results: 593 patients (median age 5.7 years, IQR 3.3-8.0 years) with scoliosis due to congenital (45%), neuromuscular (39%), and syndromic (16%) disorders underwent 5,072 procedures. The incidence of deep SSIs per patient was 12.6%; 75 patients had one or more deep SSIs. The risk of deep SSIs per procedure was 1.95% as 99 SSIs occurred after the 5072 procedures. Overall, 48% of deep SSIs followed expansion procedures. Pathogen(s) were cultured from 92% of SSIs including gram-positive cocci (GPC, 90.1%) and/or gram-negative rods (GNR, 17.6%). Methicillin-susceptible Staphylococcus aureus (48.4% of SSIs), methicillin-resistant S. aureus (23.1%), and coagulase negative staphylococci (CoNS, 8.8%) were the most common GPCs. Escherichia coli (5.5% of SSIs), Enterobacter cloacae (4.4%), and Pseudomonas aeruginosa (4.4%) were the most common among GNRs. GNR susceptibility to cefazolin was 41% during the study period, whereas GPC susceptibility to cefazolin was 59%.

Conclusion: The risk of SSIs can potentially be reduced for this vulnerable population by routinely reviewing the local epidemiology of SSIs, including the associated pathogens and their susceptibility patterns. As GNR susceptibility to cefazolin was only 41%, expanding prophylaxis to include aminoglycosides for GNR is prudent.

Level of evidence: Level IV.

Keywords: Antibiotic prophylaxis; Early onset scoliosis; Nonidiopathic scoliosis; Surgical site infection.

Publication types

  • Multicenter Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis
  • Bacteria / drug effects
  • Bacterial Infections* / drug therapy
  • Bacterial Infections* / epidemiology
  • Bacterial Infections* / microbiology
  • Bacterial Infections* / prevention & control
  • Child
  • Child, Preschool
  • Humans
  • Microbial Sensitivity Tests
  • Retrospective Studies
  • Scoliosis / surgery*
  • Spinal Fusion / adverse effects
  • Surgical Wound Infection* / drug therapy
  • Surgical Wound Infection* / epidemiology
  • Surgical Wound Infection* / microbiology
  • Surgical Wound Infection* / prevention & control


  • Anti-Bacterial Agents