Clinical implication of routine bacterial culture from epidural catheter tips in postoperative cancer patients: a prospective study

Abstract

Summary We conducted a prospective study to determine the epidural tip culture pattern and its clinical implication in postoperative cancer patients. All patients scheduled to undergo various cancer surgeries requiring epidural analgesia were included. Epidural catheter tips were sent for culture on removal. Of the 466 epidural catheter tips sent for culture, 27 showed a positive culture (5.7%). The commonest organism identified was Staphylococcus aureus. There were no signs of local or epidural space infection in any of the patients. The rates of epidural catheter tip cultures in cancer patients are comparable to those in the general patients and the presence of a positive tip culture is not a predictor of epidural space infection. Hence, we recommend that even in cancer patients, routine culture of epidural catheters is not advisable, provided strict asepsis is maintained at the time of insertion, and patients are constantly monitored for early signs of epidural infection.

Comparison of two different antiseptics on contamination of epidural catheter tip

“…Epidural kateterin giriş yerindeki bakterilerin derin dokuları kontamine etmesinin, katetere bağlı enfeksiyon gelişmesinde başlıca araç olduğu düşünülmektedir. [3,15] Maki ve ark. [12] dezenfeksiyon öncesi epidural kateterin takıldığı cilt bölgesinde normal floradaki bakteri sayısının, periferal ya da santral vasküler girişim yerine göre daha fazla olduğunu bildirmiştir.…”

Colonização e infecção em pacientes com cateter peridural não tunelizado para analgesia

“…A inserção do cateter não tunelizado ao nível torácico foi considerada, como fator de maior risco de infecção no espaço peridural, quando comparada com o nível lombar (6,18,22,26) . Em nosso estudo, não ocorreram infecções, mesmo quando a colonização relacionada ao cateter não tunelizado foi maior na região torácica em relação à lombar.…”

Transfer of the morbidly obese from anaesthetic room to theatre

“…We did not give the details of radiotherapy or chemotherapy received by the patients as there are articles to support the statement that cancer patients are at a greater risk of infection, even without chemotherapy or radiotherapy. Patients with malignancy have a systematic suppression of the host immune function and have a significantly increased risk for infection in comparison with patients without malignancy [1]. The group with absolute neutrophil count greater than 500 per microlitre and no immunosuppressive therapy represents the least immunosuppressed patients with cancer, but some level of risk of infection may still exist [2].…”

“…In Broom and colleagues' study [1], the median time between circuit disconnection in the anaesthetic room and reconnection in theatre was 44-65 s, and the median time to the first pulse oximetry recording was 90 s. Transfer of a morbidly obese patient may take considerably longer, and as mentioned by the authors, all that is needed is for a few unforeseen problems to occur during transfer, and desaturation will occur in at-risk patients who are unmonitored.…”

“…We read with interest the study on transferring patients from anaesthetic room to operating theatre [1]. This showed that patient transfer without monitoring may be prolonged.…”