Bacterial Colonization of Epidural Catheters Used for Short-term Postoperative Analgesia

Background The authors conducted this prospective study to determine the incidence, potential routes, and risk factors of microbial colonization of epidural catheter used for postoperative pain control. Methods Two-hundred five patients with epidural analgesia for postoperative pain were studied. On removal of the catheter, five samples were sent for culture: the infusate, a swab from inside the hub of the epidural catheter connector, a swab from the skin around the catheter insertion site, the subcutaneous segment, and the tip of the catheter. Clinical data related to the catheter insertion, management, and general patient conditions were collected. Results The positive culture rates for the subcutaneous and tip segments of the catheter were 10.5% and 12.2%, respectively. The most common organism in the culture was coagulase-negative staphylococcus. There was a strong linear relationship between bacterial colonization in the skin around the catheter insertion site and growth from the subcutaneous and tip segments of catheter (P = 0.000). Catheter-related events at ward, blood transfusion, and positive culture from the skin at the insertion site were risk factors for bacterial colonization of epidural catheters. Inflammation at catheter insertion site, catheter indwelling time, and level of catheter insertion were not predicators for epidural catheter colonization. Conclusions The authors' results suggest that bacterial migration along the epidural catheter track is the most common route of epidural catheter colonization. Maintaining sterile skin around the catheter insertion site will reduce colonization of the epidural catheter tip.

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Clinical and Bacteriologic Survey of Epidural Analgesia in Patients in the Intensive Care Unit

Anesthesiology ◽

10.1097/00000542-199611000-00005 ◽

1996 ◽

Vol 85 (5) ◽

pp. 988-998 ◽

Cited By ~ 71

Author(s):

Bruno Darchy ◽

Xavier Forceville ◽

Eric Bavoux ◽

Frederic Soriot ◽

Yves Domart

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Epidural Analgesia ◽

Epidural Catheter ◽

Strong Predictor ◽

Insertion Site ◽

Space Infection ◽

General Signs ◽

Epidural Catheters

Background The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors. Methods Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan. Results The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections. Conclusions The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.

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A Prospective Observational Study – Epidural Catheter Insertion Site and Adequacy of Post-Operative Pain Relief in Children undergoing Thoracic and Upper Abdominal Surgeries

Indian Journal of Anaesthesia and Analgesia ◽

10.21088/ijaa.2349.8471.51018.4 ◽

2018 ◽

Vol 5 (10) ◽

pp. 1610-1614

Author(s):

Afroz Shahana M. Khan ◽

◽

Vijaya Prakash Patil ◽

Quazi Quazi ◽

◽

...

Keyword(s):

Pain Relief ◽

Observational Study ◽

Epidural Catheter ◽

Prospective Observational Study ◽

Insertion Site ◽

Catheter Insertion ◽

Catheter Insertion Site ◽

Post Operative Pain ◽

Upper Abdominal

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Subcutaneous abscess at epidural catheter insertion site in a patient with intestinal tuberculosis

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2015.05.005 ◽

2015 ◽

Vol 27 (8) ◽

pp. 694

Author(s):

Souvik Maitra ◽

Sahir Aftab ◽

Anil Agarwal ◽

Bharathram Vasudevan

Keyword(s):

Epidural Catheter ◽

Insertion Site ◽

Intestinal Tuberculosis ◽

Catheter Insertion ◽

Catheter Insertion Site

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Chlorhexidine versus Povidone Iodine in Preventing Colonization of Continuous Epidural Catheters in Children

Anesthesiology ◽

10.1097/00000542-200102000-00012 ◽

2001 ◽

Vol 94 (2) ◽

pp. 239-244 ◽

Cited By ~ 113

Author(s):

Brian Kinirons ◽

Olivier Mimoz ◽

Leila Lafendi ◽

Thierry Naas ◽

Jean-François Meunier ◽

...

Keyword(s):

Epidural Catheter ◽

Povidone Iodine ◽

Insertion Site ◽

Culture Collection ◽

Alcoholic Solution ◽

Catheter Insertion ◽

Clinical Indication ◽

Coagulase Negative Staphylococci ◽

Skin Preparation ◽

Epidural Catheters

Background Chlorhexidine is better than povidone iodine for skin preparation before intravascular device insertion or blood culture collection, but it is not known whether chlorhexidine is superior in reducing colonization of continuous epidural catheters. Methods Children requiring an epidural catheter for postoperative analgesia longer than 24 h were randomly assigned to receive skin preparation with an alcoholic solution of 0.5% chlorhexidine or an aqueous solution of 10% povidone iodine before catheter insertion. Using surgical aseptic techniques, catheters were inserted into either the lumbar or the thoracic epidural space based on the preferences of the anesthesia team, on clinical indication, or both. Immediately before epidural catheter removal, their insertion site and hub were qualitatively cultures. After their removal, the catheter tips were quantitatively cultured. Catheters were classified as colonized when their tips yielded 1,000 or more colony-forming units/ml in cultures. Results Of 100 randomly assigned patients, 96 were evaluable. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters were kept in place for a median (range) duration of 50 (range, 21-100) h. Catheters inserted after skin preparation with chlorhexidine were one sixth as likely and less quickly to be colonized as catheters inserted after skin preparation with povidone iodine (1 of 52 catheters [0.9 per 100 catheter days] vs. 5 of 44 catheters [5.6 per 100 catheter days]; relative risk, 0.2 [95% confidence interval, 0.1-1.0]; P = 0.02). Coagulase-negative staphylococci were the only colonizing microorganisms recovered, and the skin surrounding the catheter insertion site was the origin of all the colonizing microorganisms. Conclusions Compared with aqueous povidone iodine, the use of alcoholic chlorhexidine for cutaneous antisepsis before epidural catheter insertion reduces the risk of catheter colonization in children.

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The Influence of Nursing Technique Applied at the Central Venous Catheter Insertion Site Upon the Incidence of Infection

Case Medical Research ◽

10.31525/ct1-nct03875352 ◽

2019 ◽

Author(s):

Keyword(s):

Central Venous Catheter ◽

Insertion Site ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Catheter Insertion Site

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Microbiological and scanning electron microscopic evaluation of epidural catheters

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2019-101180 ◽

2020 ◽

Vol 45 (5) ◽

pp. 381-385

Author(s):

Ganapathy van Samkar ◽

Payal P S Balraadjsing ◽

Henning Hermanns ◽

Irene V Hoogendijk ◽

Markus W Hollmann ◽

...

Keyword(s):

Epidural Catheter ◽

Bacterial Growth ◽

Bacterial Species ◽

Insertion Site ◽

Primary Source ◽

Electron Microscopic ◽

Source Of Infection ◽

Microscopic Evaluation ◽

Epidural Catheters ◽

Scanning Electron

BackgroundEpidural 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.Methods28 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.Results27 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.ConclusionsWe 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.

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