[Intraspinal infections in patients treated with epidural analgesia].
BACKGROUND
Intraspinal infections (meningitis, epidural abscess) may occur spontaneously or present as a complication of epidural analgesia.


METHODS
All cases during the 1991-99 period of clinically significant intraspinal infections in patients treated with epidural analgesia were analysed from clinical records in our institution.


RESULTS
One patient with uncertain, three patients with well documented meningitis, and one patient with epidural abscess were identified. The treatment time varied from 12 to 49 days in patients with documented infections; the number of catheters varied from one to six. Skin bacteria were isolated from one patient (Staphylococcus sp), opportunistic bacteria (Pseudomonas, Enterococcus, Micrococcus sp) were isolated from three others. Two of the patients were at risk because of probable immunosuppression and chronic infections. Diagnosis and surgery of the patient who developed epidural abscess were significantly delayed because of three negative MRs with and without gadolinium enhancement.


CONCLUSIONS
Because of the danger of infection related to epidural analgesia, all patients have to be properly monitored as long as they have epidural catheters and also after the removal of catheters. Some epidural abscesses spread longitudinally and may present as a diffuse process on MR without mechanical compression of the medulla, and may be interpreted as negative findings. Myelography with CT scan is an alternative method of investigation in such cases. Early neurosurgical diagnosis and intervention may prevent serious complications.
Løvstad
R Z
RZ
Anestesiavdelingen, Aker sykehus 0514 Oslo. renlovstad@hotmail.com
Berntsen
A G
AG
Berild
D
D
Stiris
M
M
D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D020802:Epidural Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D008875:Middle Aged; D009192:Myelography; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents