Infection during Chronic Epidural Catheterization

Pen, Stuart L. Du; Peterson, Donald G.; Williams, Anna R.; Bogosian, Armen J.

doi:10.1097/00000542-199011000-00018

Cited by 201 publications

(76 citation statements)

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“…2,10,13,33,42 Most authors suggest that the upper time limit for consideration to intervene surgically is 36-72 hours from onset of neurological sequelae. 1,9,19,23,32,36,39 Although for select patients a conservative approach of antibiotics alone might be appropriate, 11,36,37 in our study, patients with focal neurological signs or symptoms were offered immediate surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

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Section: Discussionmentioning

confidence: 99%

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Shweikeh

Saeed

Bukavina

et al. 2014

FOC

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“…In comparison, a peripheral pattern of contrast enhancement is consistent with a frank abscess containing a liquefied, purulent core. Clinically, surgically treated patients with pustular abscesses had better outcomes than patients with granular tissue or granular tissue plus pus [4]. Even with a delayed diagnosis of 3 weeks and a long segment abscess (extending through the whole spine), as seen in our patient, there was an excellent outcome without any complications.…”

Section: Discussionmentioning

confidence: 50%

“…Epidural abscess may also result from the direct spread of infection into the epidural space from a source adjacent to the spine such as spondylodiscitis, paraspinal abscess, or vertebral osteomyelitis [7,12]. Systemic illness, such as diabetes mellitus, immune deficiency states, such as AIDS or cancer, renal failure, IV drug abuse, and steroid therapy contribute to this process [1][2][3][4][5][6][7][8]. SEA in young healthy patients without any risk factors is extremely rare.…”

Section: Discussionmentioning

confidence: 99%

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Pan Spinal Epidural Abscess in a Young Healthy Male: A Case Report

Zhou¹,

Turtz²,

Levy³

2008

Scholarly Research Exchange

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Pan spinal epidural abscess is rare in a young healthy adult and may lead to permanent neurological deficits and meningitis if not treated promptly. A case is described of a pan spinal epidural abscess, from C1 to S1, in a young, healthy adult without risk factors that presented with ascending back pain and no fever. The abscess was diagnosed with MRI and treated with hemilaminotomies, surgical drainage, and antibiotics with a satisfactory outcome. The literature is reviewed herein.

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“…1) The incidence of catheter infection and meningitis is low even if the catheter is left in situ. 2,3) We found only 2 other patients who retained a fragment of lumbar drainage tube fragment. 4) The fragment was removed in one patient scheduled for ventriculoperitoneal shunting, but was left in situ in the other without eliciting complications, suggesting that retained tube fragments may be left in place unless the patient requires manipulations near the spinal cord.…”

Section: Discussionmentioning

confidence: 91%

Spinal Intradural Granuloma as a Complication of an Infected Cerebrospinal Fluid Drainage Tube Fragment -Case Report-

Aoyama

Hida

2010

Neurol. Med. Chir.(Tokyo)

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A 69-year-old man presented with subarachnoid hemorrhage due to a ruptured anterior communicating artery aneurysm. The aneurysm neck was clipped and a lumbar drainage tube was inserted for cerebrospinal fluid drainage. However, the tube was accidentally cut during removal and a fragment remained in the spinal canal. A subarachnoid, subcutaneous abscess appeared 7 days later, which was treated with antibiotics. He noted numbness of his left leg after 6 months, and gait disturbance manifested 3 months later. T 1 -weighted magnetic resonance (MR) imaging disclosed a well-enhanced extramedullary mass at the T9-10 intervertebral level, and T 2 -weighted MR imaging showed moderate edema around the peri-lesional spinal cord. The mass containing a drainage tube fragment was surgically removed. Histological examination confirmed granuloma due to chronic infection. This case suggests that retained tube fragments should be removed surgically, especially in the presence of infectious complications.

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Infection during Chronic Epidural Catheterization

Cited by 201 publications

References 0 publications

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

Pan Spinal Epidural Abscess in a Young Healthy Male: A Case Report

Spinal Intradural Granuloma as a Complication of an Infected Cerebrospinal Fluid Drainage Tube Fragment -Case Report-

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