Epidural Catheter Bacterial Colonization and Infection in a Secondary Portuguese Hospital Setting

Background and study goal Epidural analgesia is effective for postoperative pain control but carries risks of infection, including bacterial colonization. This study aimed to determine the incidence of epidural catheter colonization and infection in a Portuguese hospital, identify common microorganisms and antibiotic resistance profiles, and assess potential risk factors. Materials and methods We conducted a prospective observational study from November 2022 to March 2023 in a Portuguese secondary care center. Adult patients undergoing surgery with epidural analgesia were included. Data related to patient demographics, surgical details, and the epidural technique were collected. Incidence rates were calculated, and risk factors for colonization were analyzed. Results and discussion Overall, 215 patients were included (mean age: 52.12 years; 76.7% women). The average catheter duration was 2.66 days. The incidence of bacterial colonization was 16.3% (95% CI=11.3-21.2%), with 74.3% showing antibiotic resistance. Staphylococcus epidermidis was the most frequent isolate (37.1%). No cases of epidural space infection were observed. Exploratory analyses indicated a potential higher risk of colonization when multiple punctures were needed (adjusted odds ratio (aOR): 4.52, p=0.33). Conclusion Epidural catheter colonization occurred in 16.3% of cases, with Staphylococcus epidermidis being the predominant agent. Despite colonization, clinical infections were rare. The high rate of antibiotic resistance underscores the need for improved stewardship and aseptic practices.