title: Bacterial colonization and infection rate of continuous epidural catheters in children.
abstract: Continuous epidural infusions are widely used for postoperative analgesia in children. We prospectively studied the incidence of bacterial colonization of caudal and lumbar epidural catheters, as well as the incidence of serious systemic and local infection, in 210 children after short-term epidural analgesia. Using aseptic technique, epidural catheters were inserted into either the lumbar or the caudal epidural space based on the preferences of the anesthesia team and/or clinical indication. The integrity of the catheter and overlying transparent dressing site was evaluated by a member of the pediatric pain service at least once a day. The catheters were aseptically removed if the patient had a fever greater than 39 degrees C, if the dressing was compromised, or when epidural analgesia was no longer required. The subcutaneous portion of the catheter was semiquantitatively cultured. Cellulitis (erythema, swelling, purulent discharge, pustule formation, or tenderness) was diagnosed by examination of the epidural insertion site. The mean (+/- SD) age of patients in the caudal catheter group (n = 170) was 3 +/- 3 yr; their mean weight was 13 +/- 11 kg. The mean (+/- SD) age of patients in the epidural catheter group (n = 40) was 11 +/- 4 yr; their mean weight was 36 +/- 23 kg. All catheters remained in place for 3 +/- 1 days (range 1-5 days). There was no serious systemic infection (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) catheters. Gram-negative organisms were cultured from 16% of the caudal catheters (27 of 170) and 3% of the lumbar catheters (1 of 40). In patients treated with caudal epidural catheters, children aged >3 yr were less likely to have colonized epidural catheters than younger children. Age did not affect the probability of developing cellulitis at the insertion 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, despite bacterial colonization of caudal and lumbar epidural catheters, serious systemic and local infection after short-term epidural analgesia did not occur in our study.
  
  
  CONCLUSIONS
  Continuous epidural infusions are widely used for postoperative analgesia in children. We found no serious systemic infections after short-term (3 days) continuous epidural analgesia in children.
authors.affiliation: Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland 21287-4965, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kost-Byerly
authors.forename: J R
authors.initials: JR
authors.lastname: Tobin
authors.forename: R S
authors.initials: RS
authors.lastname: Greenberg
authors.forename: C
authors.initials: C
authors.lastname: Billett
authors.forename: M
authors.initials: M
authors.lastname: Zahurak
authors.forename: M
authors.initials: M
authors.lastname: Yaster
mesh_terms: D000038:Abscess / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015360:Analgesia, Epidural / Q000295:instrumentation*; D001419:Bacteria / Q000254:growth & development*; D001424:Bacterial Infections / Q000209:etiology*; D002404:Catheterization / Q000295:instrumentation*; D002481:Cellulitis / Q000209:etiology; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004487:Edema / Q000209:etiology; D004890:Erythema / Q000209:etiology; D005334:Fever / Q000209:etiology; D006090:Gram-Negative Bacteria / Q000254:growth & development; D006094:Gram-Positive Bacteria / Q000254:growth & development; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D016920:Meningitis, Bacterial / Q000209:etiology; D009779:Occlusive Dressings; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013492:Suppuration; D013997:Time Factors