Perspective

SSI in non-idiopathic scoliosis showed susceptibility to aminoglycosides

Pediatric patients undergoing growth-friendly surgery for non-idiopathic scoliosis experienced a decrease in gram-negative rod susceptibility to cefazolin and an increase in susceptibility to aminoglycosides, based on results presented at a meeting.

“Aminoglycosides should be seriously considered for gram-negative prophylaxis, as well as vancomycin, whether IV or, preferably local, as a powder, given susceptibility terms,” Michael G. Vitale, MD, MPH, at Columbia University Medical Center, said.

Vitale and colleagues analyzed deep surgical site infection (SSI), associated pathogens, susceptibility profiles and perioperative prophylaxis regimens among 593 pediatric patients at 11 centers who were part of the Children’s Spine Study Group database and undergoing growth-friendly surgery for non-idiopathic scoliosis.

According to Vitale, 12.6% of patients developed 99 SSIs, 90% of which were identified as gram-positive cocci and 16.5% of which were identified as gram-negative rods.

“We found gram-negatives had poor susceptibility to cefazolin, as you would imagine, but actually [had] pretty good, if imperfect, susceptibility to aminoglycosides,” Vitale said.

Gram-positives identified had excellent vancomycin susceptibility and relatively poor cefazolin susceptibility, he noted.

“Interestingly, despite the increased use of routine local vancomycin powder in the wound, there was no change in resistance to ... aminoglycosides and ... vancomycin, arguing that we are not currently seeing issues with resistance of these organisms to aminoglycosides and vancomycin,” Vitale said.

For gram-negative coverage in early onset cases, all the study sites reported using cefazolin and topical vancomycin. About 80% of the sites reported using aminoglycosides.

When surgeons pay attention to the granular details of practice, they may be able to identify more ways to decrease infection rates, Vitale told Orthopedics Today.

“As with anything else in quality ... just the act of paying attention to it often has an effect on decreasing infection rates,” he said.

Vitale added, “As we continue to improve care outcomes ... these kids are better than ever, and the risk-benefit proposition for surgical intervention, even in our most complex kids, continues to improve.” – by Casey Tingle

Disclosure: Vitale reports no relevant financial disclosures.

Pediatric patients undergoing growth-friendly surgery for non-idiopathic scoliosis experienced a decrease in gram-negative rod susceptibility to cefazolin and an increase in susceptibility to aminoglycosides, based on results presented at a meeting.

“Aminoglycosides should be seriously considered for gram-negative prophylaxis, as well as vancomycin, whether IV or, preferably local, as a powder, given susceptibility terms,” Michael G. Vitale, MD, MPH, at Columbia University Medical Center, said.

Vitale and colleagues analyzed deep surgical site infection (SSI), associated pathogens, susceptibility profiles and perioperative prophylaxis regimens among 593 pediatric patients at 11 centers who were part of the Children’s Spine Study Group database and undergoing growth-friendly surgery for non-idiopathic scoliosis.

According to Vitale, 12.6% of patients developed 99 SSIs, 90% of which were identified as gram-positive cocci and 16.5% of which were identified as gram-negative rods.

“We found gram-negatives had poor susceptibility to cefazolin, as you would imagine, but actually [had] pretty good, if imperfect, susceptibility to aminoglycosides,” Vitale said.

Gram-positives identified had excellent vancomycin susceptibility and relatively poor cefazolin susceptibility, he noted.

“Interestingly, despite the increased use of routine local vancomycin powder in the wound, there was no change in resistance to ... aminoglycosides and ... vancomycin, arguing that we are not currently seeing issues with resistance of these organisms to aminoglycosides and vancomycin,” Vitale said.

For gram-negative coverage in early onset cases, all the study sites reported using cefazolin and topical vancomycin. About 80% of the sites reported using aminoglycosides.

When surgeons pay attention to the granular details of practice, they may be able to identify more ways to decrease infection rates, Vitale told Orthopedics Today.

“As with anything else in quality ... just the act of paying attention to it often has an effect on decreasing infection rates,” he said.

Vitale added, “As we continue to improve care outcomes ... these kids are better than ever, and the risk-benefit proposition for surgical intervention, even in our most complex kids, continues to improve.” – by Casey Tingle

Disclosure: Vitale reports no relevant financial disclosures.

    Perspective
    Baron S. Lonner, MD

    Baron S. Lonner

    The authors have addressed the important subject of deep SSI in this historically vulnerable population. SSI occurred in nearly 2% of the 5,072 procedures and in 12.6% of patients. Cultures were available for 91 patients of 99 patients and 98% had greater than one pathogen identified. It is not clear if all cultures available were positive for an organism. Ninety percent had gram-positive cocci and 23% of these were methicillin resistant; 16.5% had gram-negative rods. The authors report susceptibility of the organisms to commonly used antibiotics over time, although it is unclear how those data were obtained. This information may be used to inform perioperative antibiotic regimens in this susceptible population and it can instruct future prospective studies. Inevitably, practitioners must evaluate SSI rates and profiles at their institutions and develop antibiotic protocols that address implicated pathogens and determine antibiotic susceptibilities specific to their patients.

    • Baron S. Lonner, MD
    • Mount Sinai Hospital
      New York City

    Disclosures: Lonner reports no relevant financial disclosures.