Objectives Infection is a potentially serious complication of any surgery; however there are very few studies on post-operative infection in children and none on paediatric orthopaedic surgery. The aim of this study was to establish the incidence of post-operative infection in a single paediatric orthopaedic surgeon’s practice and to evaluate associated factors.
Materials and methods Retrospective study of 1,025 consecutive paediatric orthopaedic patients aged 0 – 16, who had surgeries performed over a 10 year period (2003 – 2013). Children were identified from the theatre register. The following parameters were evaluated: incidence of post-operative infection; type of surgery based on the hospital coding system; type of infection; type of infective micro-organism.
Results The incidence of post-operative infection was 1.3% with a total number of 13. There were 2 superficial wound infections following femoral and midfoot osteotomies; 2 deep and 5 superficial infections of external fixator and Kirschner wire sites respectively; 1 deep pelvic infection following single stage open hip reduction, pelvic and femoral osteotomy; 1 skin infection secondary to soiling following closed hip reduction and adductor longus tenotomy; 1 femoral osteomyelitis following combined pelvic and femoral osteotomy; 1 urinary tract infection (UTI). In 3 patients the routine culture of an epidural tip grew bacteria without any clinical signs or symptoms, indicating contamination. The following groups of micro-organisms were isolated: MRSA (2); Staphylococcus aureus and Diphtheroids (1); Staphylococcus aureus and Coliform bacilli (2); Staphylococcus aureus (3); Enterobacter and Klebsiella (1); Staphylococcus aureus and Bacillus species (1); Enterococcus (2). The diagnosis of femoral osteomyelitis in a child with severe cerebral palsy was based on exclusion, clinical and radiological findings, without positive microbiology.
Conclusions Our study has demonstrated an incidence of 1.3% of post-operative infection in paediatric orthopaedic surgery. This is below the reported post-operative infection rate of 7.8% in adults. All our infections apart from the skin infection and UTI occurred with bony surgeries and surgeries where wires or pins were inserted. We therefore continue using prophylactic antibiotics for surgeries where metal is inserted but not for soft tissue surgeries apart from open reductions of the hip. The most common micro-organism identified was Staphylococcus aureus.