title: Meningitis or epidural abscesses after neuraxial block for removal of infected hip or knee prostheses.
abstract: BACKGROUND
  Infection, whether localized or systemic, can be a relative contraindication to neuraxial anaesthesia. Data correlating neuraxial anaesthesia and the development of meningitis or epidural abscess in this setting are limited.
  
  
  METHODS
  Retrospective chart review was performed on 710 medical records of patients admitted between 1998 and 2009 for removal of potentially infected total hip and total knee prostheses. Ultimately, 474 patients were identified as being infected. Factors that predisposed a patient to an immunocompromised state, and signs and symptoms of infection in the pre-, intra-, and postoperative stages were documented. Bacteraemic patients were reviewed for signs of neuraxial infection. The endpoint of follow-up was development of complications before hospital discharge.
  
  
  RESULTS
  All 474 patients had removal of the infected prosthesis under neuraxial anaesthesia. Mean patient age was 65.5 yr (58% >65 yr) and mean length of hospital stay was 21 days. Patient characteristics included concurrent disease (65%), steroid use (5.3%), preoperative antibiotic use (50.8%), signs of inflammatory process (84%), bacteraemia (4.2%), and documented positive intraoperative joint cultures (88%). Using clinical standards for diagnosis of central neuraxial infection, patients developed infectious complications (incidence of 0.6% on 95% confidence interval), although three patients had findings attributable to anaesthesia, including epidural haematoma, psoas abscess, and back pain.
  
  
  CONCLUSIONS
  Based on clinical criteria, our findings suggest that the incidence of central nervous system infection after neuraxial anaesthesia in patients with infected hip and knee prostheses is low after neuraxial block.
authors.affiliation: Department of Anesthesiology,  Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021,  USA.
authors.forename: K
authors.initials: K
authors.lastname: Gritsenko
authors.forename: D
authors.initials: D
authors.lastname: Marcello
authors.forename: G A
authors.initials: GA
authors.lastname: Liguori
authors.forename: K
authors.initials: K
authors.lastname: Jules-Elysée
authors.forename: S G
authors.initials: SG
authors.lastname: Memtsoudis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002648:Child; D020802:Epidural Abscess / Q000209:etiology; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D016920:Meningitis, Bacterial / Q000209:etiology; D008875:Middle Aged; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult