Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis

Abstract

BackgroundTo determine infection rate with use of epidural catheters in place for seven days or more.MethodsSystematic review and pooled analysis of observational studies.ResultsTwelve studies with 4,628 patients (median 197 patients) provided information, of which nine (4,334 patients) were published after 1990. Eight studies (3,893 patients) were retrospective, and four studies (735 patients) prospective. Electronic searches identified three studies and searching reference lists nine.There were 257 catheter-related infections in total, of which 211 were superficial and 57 deep, giving rates of 6.1%, 4.6% and 1.2% respectively. Ten of the 12 studies had deep infection rates of 2% or less. The incidence of deep infection was 1 per 2391 days of treatment, or 0.4 per 1000 catheter treatment days. In nine studies (1503 patients), predominantly in cancer, and with average catheter duration of 74 days, the deep infection rate was 2.8%. The proportion of patients with infection of any type was higher in cancer patients with longer catheter duration. Limited numbers of events meant that no reliable estimate of the impact of prospective and retrospective design could be made. There appeared to be a relationship between catheter duration and infection rate from this and other recent estimates. Four of 57 (7%) patients with deep infection died.ConclusionThe best estimate is that one person in 35 with an epidural catheter in place for 74 days for relief of cancer pain can be expected to have a deep epidural infection, and that about 1 in 500 may die of infection-related causes. This is a most uncertain estimate given the limited nature of the evidence.

23. Pain in Patients with Cancer

“…There were 6.1% catheter‐related infections, 4.6% superficial and 1.2% deep infections. The incidence of catheter‐related infections was calculated to be 0.4/1000 catheter days 16 …”

Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia

“…21 There is a considerable risk for catheterization with more than 7 days. 11 Scott et al 36 and Bevacqua et al 37 also found no association between this dwelling time and local infection. It is estimated that 1 in 35 cancer patients and prolonged epidural analgesia will have deep epidural infection and that 1 in 500 will die from related causes.…”

“…It is estimated that 1 in 35 cancer patients and prolonged epidural analgesia will have deep epidural infection and that 1 in 500 will die from related causes. 11 Anesthetics such as lidocaine and bupivacaine have bactericidal activity due to the solution acidity, particularly at high concentrations; 19,28,35,38 thus, it may be able to inhibit bacterial growth. This may explain the low occurrence of epidural catheter colonization, as almost all of them received these drugs.…”

“…6,8---10 The incidence of infection associated with epidural catheter ranges from 0.06% to 5.3% in studies with surgical patients and the rate of site-specific infections (meningitis, paraspinal and epidural abscess) ranges from 0 to 0.7%. 1,6,10,11 There are several mechanisms by which epidural catheter causes infection. First, infection may occur by contamination of the catheter emergence site or its lumen and spreads along its duct.…”

Colocación de catéter peridural en el paciente de dolor y cuidado paliativo: revisión narrativa

“…Los resultados revelan que el 6,1 % de las infecciones se relacionaban con el catéter, el 4,6 % de infecciones eran superficiales y el 1,2 % eran profundas. La incidencia de las infecciones relacionadas con el catéter se calculó en 0,4/000 días de catéter [14].…”