1Department of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA 2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 3Division of Pediatric Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA 4Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
ABSTRACT:Study Design: Retrospective cohort study using the Pediatric Health Information Systems (PHIS) database.
Objective:To describe longitudinal patterns of prophylactic antibiotic use and determinants of antibiotic choice for spinal fusion surgeries performed at US children's hospitals.Summary of Background Data: Surgical Site Infections (SSIs) account for a significant proportion of post-spinal surgery complications, particularly among children with complex conditions such as neuromuscular disease. Antimicrobial prophylaxis with intravenous (IV) cefazolin or cefuroxime has been a standard practice, but postoperative infections caused by organisms resistant to these antibiotics are increasing in prevalence. Studies describing the choice of antibiotic prophylaxis for pediatric spinal surgery are lacking.
Methods: We included children 6 months to 18 years of age discharged from 37 US children's hospitals between January 1, 2006 - June 30, 2009 with 1) an ICD9-CM procedure code indicating a spinal fusion and 2) combinations of diagnosis codes indicating adolescent idiopathic scoliosis (AIS, n = 5,617) or neuromuscular scoliosis (NMS, n = 3,633). After identifying antibiotics ordered on the operative day, we described variation in broad-spectrum antibiotic use over time, and measured associations between patient/surgery characteristics and antibiotic choice.
Results:Prophylactic antibiotic choice varied across hospitals and over time. Broad-spectrum antibiotics were used in 37% of AIS and 52% of NMS operations. Seven (19%) hospitals used broad spectrum coverage for greater than 80% of all cases. For NMS procedures, broad-spectrum antibiotic use was associated with patient characteristics known to be associated with high SSI risk. Use of vancomycin and broad gram-negative agents increased over time.
Conclusion:Broad-spectrum antimicrobial prophylaxis varied across hospitals, and was often associated with known risk factors for SSI. These results highlight the need for future studies comparing the effectiveness of various prophylaxis strategies, particularly in high risk subgroups. This research can inform the development of best practice for SSI prevention in spinal fusion procedures.