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Bacterial colonization and infection rate of continuous epidural catheters in children
S Kost-Byerly1, J R Tobin, R S Greenberg
1Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland 21287-4965, USA.
Insights
Short-term epidural analgesia in children is safe, with no serious infections observed despite bacterial colonization of catheters. This study confirms the safety of continuous epidural infusions for pediatric postoperative pain management.
Area of Science:
- Pediatric Anesthesiology
- Infectious Disease Prevention
- Pain Management
Background:
- Continuous epidural infusions are a common method for managing postoperative pain in children.
- Concerns exist regarding the risk of infection associated with indwelling epidural catheters.
Purpose of the Study:
- To prospectively evaluate the incidence of bacterial colonization and infection in pediatric patients receiving short-term caudal or lumbar epidural analgesia.
- To assess the safety of continuous epidural infusions in a pediatric population.
Main Methods:
- A prospective study involving 210 children undergoing short-term epidural analgesia.
- Epidural catheters (caudal or lumbar) were inserted using aseptic technique and monitored daily.
- Subcutaneous portions of removed catheters were cultured, and insertion sites were examined for signs of infection.
Main Results:
- 35% of epidural catheters showed bacterial colonization; Gram-positive organisms were common, with Gram-negative organisms more frequent in caudal catheters.
- No serious systemic infections (meningitis, epidural abscess, sepsis) or local infections like cellulitis were observed.
- Children over 3 years old with caudal catheters were less likely to have colonized catheters than younger children.
Conclusions:
- Despite bacterial colonization, short-term (3 days) continuous epidural analgesia in children is not associated with serious systemic or local infections.
- The findings support the continued use of epidural infusions for pediatric postoperative pain management with appropriate aseptic techniques.
Unlabelled:
Continuous epidural infusions are widely used for postoperative analgesia in children. We prospectively studied the incidence of bacterial colonization of caudal and lumbar epidural catheters, as well as the incidence of serious systemic and local infection, in 210 children after short-term epidural analgesia. Using aseptic technique, epidural catheters were inserted into either the lumbar or the caudal epidural space based on the preferences of the anesthesia team and/or clinical indication. The integrity of the catheter and overlying transparent dressing site was evaluated by a member of the pediatric pain service at least once a day. The catheters were aseptically removed if the patient had a fever greater than 39 degrees C, if the dressing was compromised, or when epidural analgesia was no longer required. The subcutaneous portion of the catheter was semiquantitatively cultured. Cellulitis (erythema, swelling, purulent discharge, pustule formation, or tenderness) was diagnosed by examination of the epidural insertion site. The mean (+/- SD) age of patients in the caudal catheter group (n = 170) was 3 +/- 3 yr; their mean weight was 13 +/- 11 kg. The mean (+/- SD) age of patients in the epidural catheter group (n = 40) was 11 +/- 4 yr; their mean weight was 36 +/- 23 kg. All catheters remained in place for 3 +/- 1 days (range 1-5 days). There was no serious systemic infection (meningitis, epidural abscess, or systemic sepsis). Of all epidural catheters, 35% (73 of 210) were colonized. Gram-positive colonization was similar in caudal (25%; 43 of 170) and lumbar (23%; 9 of 40) catheters. Gram-negative organisms were cultured from 16% of the caudal catheters (27 of 170) and 3% of the lumbar catheters (1 of 40). In patients treated with caudal epidural catheters, children aged >3 yr were less likely to have colonized epidural catheters than younger children. Age did not affect the probability of developing cellulitis at the insertion site. Although patients aged <3 yr with caudal catheters had a slightly greater risk of cellulitis than children aged >3 yr (14% vs 9%), this association was very weak (P = 0.33). We observed that, despite bacterial colonization of caudal and lumbar epidural catheters, serious systemic and local infection after short-term epidural analgesia did not occur in our study.
Implications:
Continuous epidural infusions are widely used for postoperative analgesia in children. We found no serious systemic infections after short-term (3 days) continuous epidural analgesia in children.