Epidural catheter-linked infections rare in children
MedWire News: Infections arising from use of epidural catheters in children are rare, especially when used short term use to relieve postoperative pain, research shows.
Navil Sethna (Children's Hospital Boston, Massachusetts, USA) and team say that the rate of epidural catheter-associated infections in children appears to have increased recently "because of the increased reporting and increased epidural analgesia practice."
The current study, which appears in the journal Anesthesiology, shows that the rate of such infections in children actually remains low.
But the researchers stress that they remain a serious concern, especially as epidural catheter use is expected to increase. "Delay in recognition or treatment of the infection may lead to dreadful outcomes," they say.
The catheter-related infection rate was lowest when epidural catheters were used for short-term postoperative pain relief, with six (0.06%) infections occurring in 10,437 cases drawn from the records of the Children's Hospital Boston between 1993 and 2009.
A higher rate was seen among children who received epidural analgesia for chronic pain, with seven (3.2%) infections occurring in 216 cases.
The infections comprised nine cases of cellulitis, two paravertebral musculature infections, one case of epidural inflammation, and one epidural abscess. They occurred between 3 and 11 days after catheter insertion.
Three patients required surgical drainage of subcutaneous pus, while the others received intravenous antibiotics. The most common pathogen infecting the children was methicillin-sensitive Staphylococcus aureus. A methicillin-resistant strain was identified in one child.
Sethna et al note that the most reliable indicator of infection appears to be back pain, which occurred in all children in the current study.
"Physical signs of suspected epidural infection, including severe local tenderness, pyrexia, meningism, or persistent neurologic deficit after infusion discontinuation, should be promptly investigated with magnetic resonance imaging scan to rule out infection," says the team.
"Timely antibiotic therapy is indicated while waiting for microbial sensitivity test to antibiotics."
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By Eleanor McDermid