INFECTIONS COMPLICATING TUNNELED INTRASPINAL CATHETER SYSTEMS USED TOTREAT CHRONIC PAIN

Tunneled intraspinal catheters and catheter-pump systems are increasin gly common treatments for severe chronic pain, but these long-term cat heters have caused meningitis, epidural abscesses, and other serious i nfections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated i nfections: two were meningeal (one was accompanied by an epidural absc ess and one by a pocket infection and bacteremia), four were associate d with a pocket, and one was associated with a tunnel. The infection r ate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were i solated were primarily normal skin Bora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at lea st 100 minutes (RR, 8.8; 95% CI, 1.6-50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone . Considering the severity of illness in catheter recipients, the infe ction rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CMS, the infectin g organism has an intrinsically low virulence, and the infected patien t is terminally ill.