Frequency of colonization and isolated bacteria from the tip of epidural
               catheter implanted for postoperative analgesia

Stabille, Débora Miranda Diogo; Diogo Filho, Augusto; Mandim, Beatriz Lemos da Silva; Araújo, Lúcio Borges de; Mesquita, Priscila Miranda Diogo; Jorge, Miguel Tanús

doi:10.1016/j.bjane.2014.05.015

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Scientific Articles • Rev. Bras. Anestesiol. 65 (3) • May-Jun 2015 • https://doi.org/10.1016/j.bjane.2014.05.015 copy

Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia ^☆ ☆ Study conducted at Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVE:

The increased use of epidural analgesia with catheter leads to the need to demonstrate the safety of this method and know the incidence of catheter colonization, inserted postoperatively for epidural analgesia, and the bacteria responsible for this colonization.

METHODS:

From November 2011 to April 2012, patients electively operated and maintained under epidural catheter for postoperative analgesia were evaluated. The catheter tip was collected for semiquantitative and qualitative microbiological analysis.

RESULTS:

Of 68 cultured catheters, six tips (8.8%) had positive cultures. No patient had superficial or deep infection. The mean duration of catheter use was 43.45 h (18-118) (p = 0.0894). The type of surgery (contaminated or uncontaminated), physical status of patients, and surgical time showed no relation with the colonization of catheters. Microorganisms isolated from the catheter tip were Staphylococcus aureus, Pseudomonas aeruginosa and Sphingomonas paucimobilis.

CONCLUSION:

Postoperative epidural catheter analgesia, under these study conditions, was found to be low risk for bacterial colonization in patients at surgical wards.

Epidural anesthesia; Infection; Bacteria

	Group A (n = 6) n (%)	Group B (n = 62) n (%)	p
Sex
Male	1 (16.7%)	29 (46.8%)	0.2177
Female	5 (83.3%)	33 (53.2%)

Skin color
Black	1 (16.7%)	6 (9.6%)	0.4927
White	4 (66.6%)	45 (72.7%)	1.0000
Brown	1 (16.7%)	11(17.7%)	1.0000
Mean age (years) ± SD	53.64 ± 16.44	48.00 ± 19.15	0.4311

ASA
ASA I (23)	2 (33.3%)	21 (33.9%)	0.8294
ASA II (38)	3 (50%)	35 (56.4%)
ASA III (7)	1 (16.7%)	6 (9.7%)

Associated comorbidities
Hypertenion	2 (33.3%)	26 (41.9%)	1.0000
Diabetes	0	7 (11.3%)	0.8685
IRC	0	2 (3.2%)	0.1510
Smoking	3 (50%)	19 (30.6%)	1.0000
Alcohol drinking	1 (16.7%)	5 (8.06%)	0.4383
Neoplasia	3 (50%)	30 (48.4%)	1.0000
Corticoterapy	1 (16.7%)	1(1.6%)	0.1699

Catheter insertion level
Toracic (n = 31; 45.6%)	2 (33.3%)	29 (46.8%)	0.6809
Lumbar (n = 37; 54.4%)	4 (66.7%)	33 (53.2%)

Antimicrobials
No (4/5.9%)	1 (16.7%)	3 (4.8%)	0.3150
Yes (64/94.1%)	5 (83.3%)	59 (95.2%)

Antimicrobials agents
Only cephalosporin	3 (50%)	37 (59.7%)	0.6844
Cephalosporin and metronidazol	1 (16.7%)	18 (29.0%)	1.0000
Mean time for catheter dwelling (hours) ± DP	51.10 ± 12.11	42.71 ± 19.76	0.0894

Local anesthetic used for analgesia
Ropivacaine	6 (100%)	56 (90.3%)	1.0000
Lidocaine	0	3 (4.83%)	1.0000
Bupivacaine	0	4 (6.45%)	1.0000

Surgery duration
<1 h	0	2 (3.22%)	1.0000
1–3	3 (50%)	16 (25.8%)	0.3380
>3 h	3 (50%)	44 (71%)	0.3635

	Group 1 (n = 37)			Group 2 (n = 31)
	Group A (n = 1) n (%)	Group B (n = 36) n (%)	p	Group A (n = 5) n (%)	Group B (n = 26) n (%)	p
Surgical procedure degree of contamination
Uncontaminated (clean and potentially contaminated)	1 (100%)	26 (72.2%)	1.0000	1 (20%)	17 (65.4%)	0.1337
Contaminated (contaminated and infected)	0	10 (27.8%)		4 (80%)	9 (34.6%)

ASA
I	1 (100%)	12(33.3%)	0.3514	1 (20%)	9 (34.6%)	1.0000
II	0	20 (55.6%)	0.4595	3 (60%)	15 (57.7%)	1.0000
III	0	4 (11.1%)	1.0000	1 (20%)	2 (7.7%)	0.4216

Surgical time
<1 h	0	1(2.8%)	1.0000	0	0	1.0000
1–3 h	1	12 (33.3%)	0.3514	2 (40%)	7 (26.9%)	0.6125
>3 h	0	23 (63.9%)	0.3784	3 (60%)	19 (73.1%)	0.6125

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] *Corresponding author. E-mail: deboramdiogo@yahoo.com.br (D.M.D. Stabille).

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Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia ☆ ☆ Study conducted at Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.

BACKGROUND AND OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Frequency of colonization and isolated bacteria from the tip of epidural catheter implanted for postoperative analgesia ^☆ ☆ Study conducted at Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.