Orthopedic Device-related Infections in Children: Characteristics, Treatment and Outcomes.

BACKGROUND

Orthopedic device-related infection (ODRI) is a major postoperative complication encompassing a broad spectrum of clinical situations depending on the anatomical site, type of implanted material, and patient-specific factors. Despite their clinical significance, data on ODRIs in children are scarce and standardized management guidelines are lacking. Our aim was to characterize the clinical presentation, laboratory findings, microbiological characteristics, therapeutic management and outcomes of ODRIs in children.

METHODS

We conducted a retrospective, observational study at Montpellier University Hospital from January 2015 to June 2023. All children under 16 years with an ODRI diagnosis, defined as the presence of clinical signs requiring surgical revision, were included.

RESULTS

Sixty-nine ODRI cases were analyzed. Initial surgical indications were: 25 fractures, 16 cases of nonidiopathic scoliosis (NIS), 12 of idiopathic scoliosis (IS) and 16 other orthopedic anomalies. Infections were polymicrobial in 35% of cases. Staphylococcus aureus (SA) was isolated in 39/69 cases, Gram-negative bacteria (GNB) in 13/69 cases and anaerobic bacteria in 9/69 cases (none on fracture cases). SA was involved in 72% of fracture-related ODRI. 50% of NIS were affected by GNB and 58% of IS by anaerobic bacteria. Empirical antibiotic treatment was mainly piperacillin/tazobactam and vancomycin (n = 38). Median duration of intravenously antibiotic therapy was 15 days [interquartile range (IQR) 10-18.5]. Median duration of total antibiotic therapy was 60 days (IQR 44.5-92), 46.5 days (IQR 42-61.75) with implant removal and 63.5 days (IQR 42.25-96.5) with implant retention. The cure rate in our cohort was 85%.

CONCLUSIONS

SA is the first cause of ODRIs in children. GNB predominates in the case of NIS and anaerobic bacteria in the case of IS. Surgical indications and comorbidities are essential to determine antibiotic prophylaxis, antibiotic therapy and optimize their duration.