Infections from extended epidural catheterization in ambulatory patients

Area of Science:

• Pain Management
• Infectious Disease Epidemiology

Background:

• Severe and noncancer pain management often requires prolonged analgesia.
• Home-based epidural infusions offer an alternative to inpatient care.

Purpose of the Study:

• To determine the incidence of infection in patients receiving prolonged home epidural infusions of analgesics.
• To evaluate the potential benefit of prophylactic antibiotics in reducing infection rates.

Main Methods:

• A study involving 504 adult patients receiving intermittent epidural infusions (bupivacaine and fentanyl) for 2-80 days at home.
• Infection diagnosis based on clinical signs (fever, pain, leukocytosis) and imaging (CT, epidurogram, sonogram).
• Comparison of infection rates between patients receiving and not receiving prophylactic antibiotics (penicillin or erythromycin).

Main Results:

• A low overall infection rate of 0.27% (9 out of 3,164 infusions) was observed.
• Infections included epidural abscesses, fascitis, and cellulitis, predominantly caused by Staphylococcus epidermidis.
• Prophylactic antibiotic use was associated with a reduced infection rate (0.11% vs. 0.4%).

Conclusions:

• Home epidural analgesia for up to 80 days is a viable option for severe pain with a low risk of infection.
• Intermittent prophylactic antibiotics appear to further decrease infection incidence.
• Findings may not be generalizable to epidural infusions exceeding 80 days.