BACTERIAL-COLONIZATION AND INFECTION-RATE OF CONTINUOUS EPIDURAL CATHETERS IN CHILDREN

Continuous epidural infusions are widely used for postoperative analge sia in children. We prospectively studied the incidence of bacterial c olonization of caudal and lumbar epidural catheters, as well as the in cidence of serious systemic and local infection, in 210 children after short-term epidural analgesia. Using aseptic technique, epidural cath eters were inserted into either the lumbar or the caudal epidural spac e based on the preferences of the anesthesia team and/or clinical indi cation. The integrity of the catheter and overlying transparent dressi ng site was evaluated by a member of the pediatric pain service at lea st once a day. The catheters were aseptically removed if the patient h ad a fever greater than 39 degrees C, if the dressing was compromised, or when epidural analgesia was no longer required. The subcutaneous p ortion of the catheter was semiquantitatively cultured. Cellulitis (er ythema, swelling, purulent discharge, pustule formation, or tenderness ) was diagnosed by examination of the epidural insertion site. The mea n (+/- so) age of patients in the caudal catheter group (n = 170) was 3 +/- 3 yr; their mean weight was 13 +/- 11 kg. The mean (+/- so) age of patients in the epidural catheter group (n = 40) was 11 +/- 4 yr; t heir mean weight was 36 +/- 23 kg. All catheters remained in place for 3 +/- 1 days (range 1-5 days). There was no serious systemic infectio n (meningitis, epidural abscess, or systemic sepsis). Of all epidural catheters, 35% (73 of 210) were colonized. Gram-positive colonization was similar in caudal (25%; 43 of 170) and lumbar (23%; 9 of 40) cathe ters. Gram-negative organisms were cultured from 16% of the caudal cat heters (27 of 170) and 3% of the lumbar catheters (1 of 40). In patien ts treated with caudal epidural catheters, children aged >3 yr were le ss likely to have colonized epidural catheters than younger children. Age did not affect the probability of developing cellulitis at the ins ertion site. Although patients aged <3 yr with caudal catheters had a slightly greater risk of cellulitis than children aged >3 yr (14% vs 9 %), this association was very weak (P = 0.33). We observed that, despi te bacterial colonization of caudal and lumbar epidural catheters, ser ious systemic and local infection after short-term epidural analgesia did not occur in our study. Implications: Continuous epidural infusion s are widely used for postoperative analgesia in children. We found no serious systemic infections after short-term (3 days) continuous epid ural analgesia in children.