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Infection is a potentially serious complication of epidural analgesia and with an increase in its use in wards there is a necessity to demonstrate its safety. We aimed to compare the incidence of colonization of epidural catheters retained for short duration (for 48 h) postoperative analgesia in postanesthesia care unit and wards. It was a prospect...
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Citations
... [75]. The most common bacterium in epidural indwelling catheter-related infections was Staphylococcus epidermidis (79%), followed by E. coli (17%), S. aureus (4%), and Klebsiella species (4%) [76]. ...
... The causative bacteria from the blood or catheter tip were Staphylococcus species, Candida species, and non-tuberculosis Mycobacterium in order of frequency [82]. The choice of an antibiotic is exactly the same as in the treatment of the epidural indwelling catheter with a subcutaneous injection port [76,80]. ...
As the field of interventional pain management (IPM) grows, the risk of surgical site infections (SSIs) is increasing. SSI is defined as an infection of the incision or organ/space that occurs within one month after operation or three months after implantation. It is also common to find patients with suspected infection in an outpatient clinic. The most frequent IPM procedures are performed in the spine. Even though primary pyogenic spondylodiscitis via hematogenous spread is the most common type among spinal infections, secondary spinal infections from direct inoculation should be monitored after IPM procedures. Various preventive guidelines for SSI have been published. Cefazolin, followed by vancomycin, is the most commonly used surgical antibiotic prophylaxis in IPM. Diagnosis of SSI is confirmed by purulent discharge, isolation of causative organisms, pain/tenderness, swelling, redness, or heat, or diagnosis by a surgeon or attending physician. Inflammatory markers include traditional (C-reactive protein, erythrocyte sedimentation rate, and white blood cell count) and novel (procalcitonin, serum amyloid A, and presepsin) markers. Empirical antibiotic therapy is defined as the initial administration of antibiotics within at least 24 hours prior to the results of blood culture and antibiotic susceptibility testing. Definitive antibiotic therapy is initiated based on the above culture and testing. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria infections appears to be superior to monotherapy in mortality with the risk of increasing antibiotic resistance rates. The never-ending war between bacterial resistance and new antibiotics is continuing. This article reviews prevention, diagnosis, and treatment of infection in pain medicine.
... Harde et al. identified the same microorganism in skin swab and EC tip cultures performed in the same patient, showing a significant correlation between bacterial colonization of the skin around the EC's insertion site and its tip. 17 Infection of CNS depends on several maneuvers, since the EC's placement until its removal: sterile dressing, skin disinfection, LA solution or catheter handling, removal and ward handling protocols. 9,17 Although we do not have data about patient skin wash, disinfectant solution type neither disinfection times, according to our protocol, we should do skin wash with neutral solution, skin disinfection with 10% povidone iodine nonalcoholic solution with adequate drying times. ...
Background
Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block.
Methods
A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed.
Results
From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge.
Conclusion
Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
... 4 5 The colonization rate of epidural catheters is higher than that of actual infection, varying from 5% to 30%, with coagulase-negative staphylococci (CNS) being the most frequent pathogen. [4][5][6][7][8][9] There are various proposed routes of epidural catheter colonization. Skin flora may spread along the catheter or its lumen, or become a source of contamination during needle or catheter insertion. ...
Background
Epidural catheters are frequently colonized by gram-positive bacteria. Although the incidence of associated epidural infections is low, their consequences can be devastating. We investigated bacterial growth on epidural catheters by quantitative bacterial culture and scanning electron microscopy (SEM) in order to explore the patterns of epidural catheter colonization.
Methods
28 patients undergoing major abdominal surgery with thoracic epidurals (treatment ≥72 hours) were studied. Before the removal of the catheter, the skin surrounding the insertion site was swabbed. The entire catheter was divided into extracorporeal, subcutaneous, and tip segments. Skin swabs and catheter segments were quantitatively cultured, bacterial species were identified, and SEM was performed on four selected catheters.
Results
27 of 28 catheters were included. The percentages of positive cultures were: skin swab 29.6%, extracorporeal segments 11.1%, subcutaneous segments 14.8%, and tip segments 33.3%. One patient was diagnosed with a catheter-associated infection. Staphylococcus epidermidis was cultured from the skin and the catheter extracorporeal, subcutaneous, and tip segments. SEM of this catheter showed bacteria-like and intraluminal host cell-like structures. SEM of two other catheters showed intraluminal fibrin networks in their tip segments.
Conclusions
We present the first SEM pictures of an epidural catheter with a bacterial infection. Bacterial growth developed from the skin to the tip of this catheter, indicating the skin as a primary source of infection. By SEM, catheters with low levels of bacterial growth demonstrated an intraluminal fibrous network which possibly plays a role in catheter obstruction.
... Ни у кого из обследованных не было каких-либо признаков воспаления в месте установки катетера, не наблюдалось ни одного случая развития эпидурального абсцесса, инфекции ЦНС или системной инфекции. Данные факты подтверждают мнение, что колонизация не эквивалентна инфекции [14]. ...
... This was missed in this case. However, a positive epidural catheter tip culture alone is not a reliable predictor of epidural space infection, [3] and the role of empirical extended antibiotic course to treat colonisation is unclear. [4] Our patient had fever and backache with no accompanying radicular signs, which subsided with symptomatic management. ...
Катетеризация для проведения продленной регионарной анестезии создает потенциальные условия для развития инфекционных осложнений. Частота их невелика, но в случае возникновения может привести к серьезным последствиям для пациента, а также увеличить длительность его пребывания в стационаре. Колонизация катетера микрофлорой в количестве 105 КОЕ и более означает, что имеется риск развития инфекционного осложнения. Цель исследования: определить стратегию регионарной анестезии на основе данных о колонизации катетера в зависимости от способа его фиксации и длительности использования, а также определить превалирующий вид высеваемой микрофлоры. Материалы и методы. В проспективное, открытое, сравнительное, одноцентровое исследование было включено 87 пациентов от 2 до 18 лет. Всем пациентам проводилась продленная регионарная анестезия, и в зависимости от способа фиксации катетера они были разделены на 3 группы: в первой группе применялась адгезивная наклейка (ФН), во второй — адгезивная наклейка и антимикробное покрытие Дезитол В (ФН + Д), в третьей проводилась туннелизация катетера (ФТ). Бактериологическое исследование микробной обсемененности проводилось классическим способом. Результаты. Ни у одного из 87 пациентов не было зарегистрировано признаков локального или системного инфекционного процесса. Разница в частоте колонизации между группами ФН и ФТ была статистически достоверна: χ2 (1,N = 65) = 6,45 странные показатели (p = 0,011), между группами ФН и ФН + Д — недостоверна. Относительный риск колонизации кожной части катетера при фиксации наклейкой в 2,25 раза выше, чем при туннелизации катетера: RR = 2,25 (р = 0,05) (95 % ДИ 1,069–4,73). В группе ФН + Д колонизация как кожной, так и внутренней части катетера отмечалась на достоверно более ранних сроках, чем в группе ФТ: кожная часть — U = 6,5; Uкр = 10; р = 0,018; внутренняя часть — U = 6; Uкр = 6; р = 0,047. При положительных результатах бактериального анализа наиболее часто была выявлена культура St. epidermidis (48,3 %) и St. aureus (19,3 %). Вывод. При планировании послеоперационного обезболивания длительностью 3 суток и более туннелизация является предпочтительным методом фиксации катетера.
Catheterization for prolonged regional anesthesia brings about potential conditions for the development of infectious complications. The frequency of their occurrence is low, but, in case of occurrence, it can lead to serious consequences for the patient, as well as increase the duration of stay in the hospital. Colonization of the catheter with microflora in the amount of 105 CFU or more means that there is a risk of developing an infectious complication. Objectives. To determine the strategy of regional anesthesia based on data for catheter colonization depending on the method of its fixation and duration of use, as well as to determine the prevailing type of microflora inoculated. Materials and methods. A prospective, open, comparative, single-center study included 87 patients aged 2 to 18 years. All patients underwent prolonged regional anesthesia, and depending on the method of fixing the catheter were divided into 3 groups — in the first group catheter was fixed with an adhesive sticker (AS), in the second — an adhesive sticker used with the antimicrobial coating Desitol V (AS + D), in the third catheter tunneling (T) was applied. Bacteriological study of microbial contamination was carried out in the classical way. Results. None of the 87 patients had signs of a local or systemic infection. The difference in the frequency of colonization between the FN and FT groups was statistically significant: χ2 (1,N = 65) = 6.45 (p = 0,011), between the FN and FN + D groups it was not significant. The relative risk of colonization of the skin part of the catheter when fixing with a sticker is 2.25 times higher than when tunneling the catheter: RR = 2.25 (p = 0.05) (95 % CI 1.069–4.73). In the FN + D group, colonization of both the skin and the inner part of the catheter was noted at significantly earlier periods than in the PT group: skin part: U = 6,5; Ucr = 10; p = 0,018; inner part: U = 6; Ucr = 6; p = 0,047. With positive results of bacterial analysis, the culture of St. epidermidis (48,3 %) and St. aureus (19,3 %). Conclusion. When planning postoperative analgesia lasting 3 days and more, tunneling is the preferred method of catheter fixation.
BACKGROUND: Infectious complications related to prolonged epidural and peripheral regional anesthesia are quite rare. However, this does not exclude the necessity of strict adherence to measures aimed at preventing microbial colonization of catheters for regional anesthesia. Microbial colonization of the catheter is not always accompanied by the development of infectious complications but increases the likelihood of their occurrence. AIM: To determine the frequency of colonization, the qualitative and quantitative composition of the microflora depending on the various methods of fixing of the catheter and the duration of its use. MATERIALS AND METHODS: 76 patients from 2 to 18 years old with prolonged epidural or peripheral anesthesia were included in an comparative, prospective, randomized, single-center study. Patients were divided into the groups according to the method of catheter fixation - adhesive sticker (AS), adhesive sticker and antimicrobial coating Desitol B (AS+D) and tunneling (T). Determination of microbial contamination of catheters was carried out using classical bacteriological studies. RESULTS: None of the 76 patients had signs of a local or systemic infection. The difference in the frequency of colonization between the AS and T groups was statistically significant: 2 (1, n = 54) = 5.5381 (p = 0.018), between the AS and AS+D groups it was not significant. The relative risk of colonization of the skin of the catheter with adhesive fixation was 2.14 times higher than with catheter tunneling: RR = 2.14, p = 0.05 (95% CI 1.04.49). In the AS+D group, colonization of both the skin and the inner part of the catheter was observed significantly earlier than in the T group: skin part: U = 5.5; Ucr = 8 (p = 0.02); inner part: U = 5.5; Ucr = 6 (p = 0.04). The growth of Staphylococcus epidermidis (48.3%) and Staphylococcus aureus (20.7%) was fixed mainly when positive results of microbiological culture takes place. CONCLUSIONS: Tunneling is the preferred method of fixation of the catheter when the postoperative pain relief period is more than 3 days.
