CLINICAL AND BACTERIOLOGICAL SURVEY OF EPIDURAL ANALGESIA IN PATIENTSIN THE INTENSIVE-CARE UNIT

Background: The risk of bacterial contamination related to epidural an algesia in patients cared for in the intensive care unit has not been assessed, Thus the authors studied patients who received care in the i ntensive care unit who were given epidural analgesia for more than 48 h to determine the rates of beat, epidural catheter, and spinal space infection and to identify risk factors. Methods: Each patient receivin g epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken i f there was local discharge; all epidural catheters were cultured on w ithdrawal. All patients underwent weekly neurologic monitoring for 1 m onth; those with positive epidural catheter cultures had one spinal ma gnetic resonance image scan. Results: The 75 patients cared for in the intensive care unit who were studied had been receiving epidural anal gesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twe nty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local ( 12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive e pidural catheter culture. No spinal space infection was diagnosed. Sta phylococcus epidermidis was the most frequently cultured microorganism . Local infection was treated by removing the epidural catheter withou t any antibiotics. Concomitant. infection at other sites (21 of 75 pat ients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the du ration of epidural analgesia, and the insertion site level of the epid ural catheter were not identified as risk factors for epidural analges ia-related infections. Conclusions: The risk of epidural analgesia-rel ated infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.