Is it essential to remove implants in children with postoperative infections?

Infections associated with spinal implants following paediatric spine deformity surgery can be treated without removing the hardware in some patients, a study has shown. Early presentation and recognition contribute to better retention rates and are associated with certain organisms.

In total, 933 procedures were carried out during the study period in 580 children. The most common pathologies that warranted operation were idiopathic scoliosis in 257 children (44.3 percent) and neuromuscular scoliosis in 192 children (33.1 percent).

Surgical site infections occurred in 35 children (6.03 percent), of which nine (1.55 percent) were associated with the implant. Children with neuromuscular spinal deformity were nearly three times more likely to get infections than those with idiopathic scoliosis (11.5 percent vs 3.89 percent). The most frequently isolated organism was methicillin-sensitive Staphylococcus aureus (n=15).

Four implant-related infections were resolved without removing the hardware, all of which had been detected within 32 days (median 20 days) and cultured either Staphylococcus aureus or Pseudomonas aeruginosa. In contrast, infections requiring implant removal had a delayed diagnosis (median 175 days) and usually cultured Cutibacterium acnes and coagulase-negative Staphylococci.

In this retrospective, observational study, children who underwent spinal surgery from January 2015 to June 2021 in a tertiary paediatric spinal surgery referral centre in Queensland, Australia, were assessed. The authors reviewed records to identify those who acquired surgical site infection postoperatively, focusing on those with implant-related infections. They also analysed preoperative prophylaxis, microbiology, clinical course, and outcomes.

“Further exploration of specific preventative strategies may be key in preventing devastating late-onset infections,” the authors said.