[Severe infections after epidural catheterization]

Abstract

The paper reviews the literature relevant to the formation of spinal epidural abscess with or without concurrent meningeal infection following epidural catheterisation. The incidence of spinal epidural abscess lies probably in the area of 1:5000 catheterisations. Immunocompromised patients and patients with catheters in situ for more than 48 hrs. are particularly prone to develop epidural abscesses. S. aureus is isolated in 35-82% of the cases. The diagnosis based upon clinical findings, laboratory studies and MRI or CT plus myelography. The mortality is 5-10%. The treatment consists of removal of the catheter, microbiological studies, surgical decompression of the spinal cord, and prolonged antibiotic treatment. It is suggested that insertion of epidural catheters is performed under strict sterility, and that disposable syringes and unbroken vials are used for each injection, which should be administered through an epidural filter. The dressing should be changed daily simultaneously with review of the patient and the insertion site.