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Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections
G Paul1, A Meißner2, J Neuneier3
1Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
Background:
Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI).
Methods:
A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases.
Findings:
Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections.
Conclusions:
SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
Insights
An outbreak of Pseudomonas aeruginosa infections occurred after computed tomography (CT)-guided spinal injections (SI). Failures in asepsis likely caused these difficult-to-treat spinal infections, which had a high relapse rate.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Public Health
Background:
- Spinal infections and meningitis due to Gram-negative bacteria following local injections for chronic back pain are rare.
- This study investigated an outbreak of Pseudomonas aeruginosa infections linked to computed tomography (CT)-guided spinal injections (SI).
Purpose of the Study:
- To investigate an outbreak of P. aeruginosa infections following CT-guided SI.
- To identify risk factors and outcomes associated with these infections.
Main Methods:
- A case definition was established for P. aeruginosa spinal infection or meningitis post-SI.
- Data were collected from patients undergoing CT-guided SI between January 10 and March 1, 2019.
Main Results:
- Twenty-eight of 297 patients developed meningitis or spinal infections post-SI.
- P. aeruginosa was microbiologically confirmed in 15 patients; 4 were probable cases.
- Most patients presented with back pain, required surgery, and experienced relapses; one patient died.
Conclusions:
- CT-guided SI, while generally safe, carries risks if aseptic techniques are compromised.
- P. aeruginosa spinal infections are challenging to treat and associated with significant morbidity and high relapse rates.
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