ArticlePediatric surgery international2025
Salvage of the infected Nuss bar: a protocol and institutional experience.
Article in Pediatric surgery international, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundSurgical implant infections often necessitate early hardware removal, complicating patient care. Nuss bars are placed via minimally invasive surgery to correct pectus excavatum. While rare, Nuss bar infections may be salvaged with prolonged antibiotics. However, no standardized protocols exist to guide management and prevent premature removal.
methodsThis study describes the implementation of a Nuss bar infection salvage protocol. This protocol was developed and implemented for six adolescent patients who underwent minimally-invasive Nuss bar implantations for pectus excavatum and suffered subsequent device-related infection between October 2021 and October 2024. Infection was determined both clinically and intraoperatively and confirmed with positive culture results. Detailed chart review was completed in patients who had infections.
results221 Nuss procedures were performed during the study period with six patients found to have an implant infection for an infection rate of 2.7%. Infections presented from 9 to 61 days following initial placement, with a median of 26 days. Five of six infections were associated with growth of Staphylococcus aureus. Four of these were methicillin-sensitive, while one was methicillin-resistant. The sixth patient’s intraoperative cultures were positive for Pseudomonas aeruginosa. Based on the developed protocol, all patients underwent 2–4 operative washouts and debridement procedures with negative pressure wound therapy between procedures. They were initially treated with broad-spectrum antibiotics and culture-directed antibiotic therapy for a total of 12 weeks. Five of six patients were transitioned to early oral antibiotics at discharge, and one required 12 weeks of intravenous antibiotics due to severe oral aversion. All patients retained their hardware and had no evidence of relapse of infection following completion of their salvage therapy.
conclusionsNuss bar infections are rare. Experience has demonstrated successful salvage with a standardized protocol incorporating 12 weeks of directed antibiotic therapy, serial washouts, and close follow-up, with no relapses of infection.
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