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Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children. Reg Anesth 1997;22(5):428-31

Date

10/27/1997

Pubmed ID

9338903

DOI

10.1016/s1098-7339(97)80028-4

Scopus ID

2-s2.0-0030874042 (requires institutional sign-in at Scopus site)   81 Citations

Abstract

BACKGROUND AND OBJECTIVES: Continuous epidural analgesia has been used with increasing frequency to provide postoperative pain relief for children. Epidural space infection is a potential complication of epidural catheter placement. This study investigated the incidence of bacterial colonization on lumbar and caudal epidural catheter tips in postoperative pediatric patients.

METHODS: In this prospective study, lumbar and caudal epidural catheters were placed in the operating room with aseptic technique. Dilute local anesthetic and/or opioid infusions were used for postoperative analgesia. On discontinuation of the epidural infusion, the skin site was decontaminated with 70% alcohol and then cultured. The distal catheter tip and hub were cultured. Semiquantitative and qualitative aerobic cultures were performed.

RESULTS: Data from 91 epidural catheters were available (45 caudal versus 46 lumbar). Of the 45 caudal catheter tips 9 (20%) were colonized, compared with 2 of the 46 (4%) lumbar catheter tips (P < .02). Staphylococcus epidermidis was the predominant skin and catheter tip organism isolated in both groups. Four of nine caudal catheter tips grew gram-negative bacteria. Statistical analyses did not show that time, skin site inflammation, or dressing condition were independent predictors of catheter tip colonization. No patient developed a clinical epidural infection during the study period.

CONCLUSIONS: The results of this study suggest that the risk of clinical epidural infection associated with caudal or lumbar postoperative catheters is low. However, the incidence of epidural catheter tip colonization is increased with the caudal route of insertion, and the bacteria differ from those cultured from the lumbar insertion site.

Author List

McNeely JK, Trentadue NC, Rusy LM, Farber NE

Author

Lynn M. Rusy MD Professor in the Anesthesiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aerobiosis
Analgesia, Epidural
Anesthesia, Spinal
Bacteria
Catheterization
Child
Female
Humans
Male
Pain, Postoperative
Prospective Studies
Skin