PHILADELPHIA, PA—Compared with cefazolin, perioperative monotherapy with vancomycin or clindamycin in pediatric spine fusion cases resulted in a 251.5% increase in rate of surgical site infections (SSIs), investigators reported at IDWeek 2014.

Despite vancomycin or clindamycin being used in only 7.1% of cases, “this small group accounted for 11.6% of our surgical site infections,” stated Ritika Coelho, MD, Pediatric Infectious Diseases, Cleveland Clinic Children’s Hospital, Cleveland, OH, and colleagues.

The investigators retrospectively explored risk factors for deep SSIs in patients younger than 18 years who underwent a posterior spine fusion procedure between 2006 and 2013. Infections were classified as early (<1 month) or late (1 month–1 year), and data was obtained on S. aureus colonization and screening and penicillin by chart review.

SSIs developed in 3.6% (22 of 608) children within one year. Among those who received cefazolin, the surgical site infection rate was 3.3% (17 of 513 children), compared with 7.6% for vancomycin (2 of 26 children; P=0.2) and 17.6% for clindamycin (3 of 17; P=0.01).

“The rate for cefazolin plus vancomycin or clindamycin was 0% (0 of 43), which was significantly lower than for vancomycin or clindamycin (P=0.05), but not for cefazolin (P=0.6),” they reported. Patients treated with vancomycin or clindamycin versus cefazolin had a higher rate of early infections (9.3%, P=0.02).

Clindamycin use was significantly associated with both Gram-positive (17.6%, P=0.01) and Gram-negative infections (11.7%, P=0.009), and a risk factor for SSI with Propionibacterium acnes (4 of 513 vs. 3 of 17; P=0.0009).

The penicillin allergy rate was 5.8% for cefazolin, 58.4% for vancomycin (p<0.0001), and 88.2% for clindamycin (p<0.0001).

The screening rate for Staphylococcus aureus colonization was 21% for cefazolin, 38.5% for vancomycin (p=0.05), and 17.6% for clindamycin. None of the 4 patients colonized with methicillin-resistant S. aureus (MRSA) developed a SSI; three were treated with cefazolin and one with vancomycin.

“Efforts need to be directed at identifying those patients who require preoperative allergy evaluation and at promoting the use of cefazolin for those patients who do not have a true contraindication to cephalosporin use,” concluded Dr Coelho. “When surgical prophylaxis with vancomycin or clindamycin is indicated, combination therapy with cefazolin should be strongly considered.”