Characteristics of Pediatric S aureus Implant-Associated Infections

Immediate implant removal or surgery and antibiotic therapy may be successful in children with implant-associated Staphylococcus aureus infections, according to study results published in Pediatric Infectious Diseases.

Although advances in implantable medical devices have been life-changing for pediatric patients, implant-associated infections caused by bacteria adhering to the implants and forming biofilms ultimately lead to substantial morbidity and hospitalization costs. Device-associated infections and surgical site infections together account for 47.4% of all healthcare-associated infections in the United States. Further, S aureus is the second most common causative pathogen for healthcare-associated infections and the most frequent cause of orthopedic implant infections. Therefore, this study described the clinical features and outcomes of pediatric patients with S aureus implant-associated infections at Texas Children’s Hospital in Houston.

A total of 45 patients with 47 implant-associated infections were identified from a S aureus surveillance database from 2008 to 2016 and clinical and demographic data were collected retrospectively. A statistical analysis of data was performed using Fisher’s exact test.

Of the 45 patients included in the study, most had an infected implant, which included spinal rods (47%) and other orthopedic hardware (40%). Within 90 days of implant placement, 64% of patients subsequently developed an implant-associated infection. Bacteremia occurred in 3 patients and polymicrobial infections occurred in 6. Of the 47 isolates identified, 28% were methicillin-resistant S aureus and 72% were methicillin-susceptible S aureus.

Further, all patients underwent at least 1 surgical incision and drainage and antibiotic therapy. Implants were removed at the time of initial presentation in 22 cases, delayed implant removal occurred in 7 cases, and the implants remained in place in 18 cases. In the patients who underwent immediate implant removal, 100% successful treatment was achieved; successful treatment was achieved in 83% of patients with implant retention, which included 10 patients who had early postoperative infections (<3 months) and 5 with late postoperative infections (>3 months). Throughout the study, only 4 patients had infection recurrence.

Overall, the study investigators concluded that, “[I]mplementation of infection prevention practices directed at S aureus screening and decolonization may decrease the risk of [implant-associated infections] in children.”

Reference

Foster CE, Lamberth LB, Kaplan SL, Hulten KG. Clinical characteristics and outcomes of Staphylococcus aureus implant-associated infections in children [published online April 1, 2019]. Pediatr Infect Dis. doi:10.1097/INF.0000000000002349