title: Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.
abstract: We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: Juliaan R M
authors: JR
authors: van Rappard
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: Jip L
authors: JL
authors: Tolenaar
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: Anke B
authors: AB
authors: Smits
authors: Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
authors: Peter M N Y H
authors: PM
authors: Go
mesh_terms: D000698:Analgesia / Q000009:adverse effects* / Q000379:methods; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002404:Catheterization / Q000009:adverse effects*; D057785:Catheters / Q000009:adverse effects; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D020802:Epidural Abscess / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D004824:Epidural Space / Q000382:microbiology* / Q000473:pathology; D005260:Female; D005436:Floxacillin / Q000627:therapeutic use; D005682:Gadolinium; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008581:Meningitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D011184:Postoperative Period; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D013211:Staphylococcus aureus
chemical_list: D000900:Anti-Bacterial Agents; D005436:Floxacillin; D005682:Gadolinium