Darchy B, Forceville X, Bavoux E, Soriot F, Domart Y
Service de Réanimation Médicochirurgicale, Centre Hospitalier de Compiègne, France.
Anesthesiology. 1996 Nov;85(5):988-98. doi: 10.1097/00000542-199611000-00005.
The risk of bacterial contamination related to epidural analgesia in patients cared for in the intensive care unit has not been assessed. Thus the authors studied patients who received care in the intensive care unit who were given epidural analgesia for more than 48 h to determine the rates of local, epidural catheter, and spinal space infection and to identify risk factors.
Each patient receiving epidural analgesia for longer than 48 h was examined daily for local and general signs of infection. A swab sample for culture was taken if there was local discharge; all epidural catheters were cultured on withdrawal. All patients underwent weekly neurologic monitoring for 1 month; those with positive epidural catheter cultures had one spinal magnetic resonance image scan.
The 75 patients cared for in the intensive care unit who were studied had been receiving epidural analgesia for a median of 4 days (interquartile range, 3.5 to 5 days). Twenty-seven patients had signs of local inflammation (erythema or local discharge), and nine of these had infections. All the patients who had both local signs also had infection. All nine infections were local (12%), but four patients also had epidural catheter infections (5.3%). No patient with erythema alone or without local signs had a positive epidural catheter culture. No spinal space infection was diagnosed. Staphylococcus epidermidis was the most frequently cultured microorganism. Local infection was treated by removing the epidural catheter without any antibiotics. Concomitant infection at other sites (21 of 75 patients, or 28%), antibiotic therapy (64 of 75 patients, or 85%), the duration of epidural analgesia, and the insertion site level of the epidural catheter were not identified as risk factors for epidural analgesia-related infections.
The risk of epidural analgesia-related infection in patients in the intensive care unit seems to be low. The presence of two local signs of inflammation is a strong predictor of local and epidural catheter infection.
在重症监护病房接受治疗的患者中，与硬膜外镇痛相关的细菌污染风险尚未得到评估。因此，作者对在重症监护病房接受治疗且接受硬膜外镇痛超过48小时的患者进行了研究，以确定局部、硬膜外导管和椎管内感染的发生率，并识别危险因素。
对每位接受硬膜外镇痛超过48小时的患者每天检查局部和全身感染迹象。如有局部渗液则采集拭子样本进行培养；所有硬膜外导管在拔除时进行培养。所有患者每周进行1个月的神经学监测；硬膜外导管培养阳性的患者进行一次脊髓磁共振成像扫描。
研究的75例在重症监护病房接受治疗的患者接受硬膜外镇痛的中位时间为4天（四分位间距为3.5至5天）。27例患者有局部炎症迹象（红斑或局部渗液），其中9例发生感染。所有有局部体征的患者均发生感染。所有9例感染均为局部感染（12%），但4例患者也有硬膜外导管感染（5.3%）。仅出现红斑或无局部体征的患者硬膜外导管培养均为阴性。未诊断出椎管内感染。表皮葡萄球菌是最常培养出的微生物。局部感染通过拔除硬膜外导管进行治疗，未使用任何抗生素。其他部位的合并感染（75例患者中的21例，即28%）、抗生素治疗（75例患者中的64例，即85%）、硬膜外镇痛持续时间以及硬膜外导管的插入部位水平未被确定为硬膜外镇痛相关感染的危险因素。
重症监护病房患者中硬膜外镇痛相关感染的风险似乎较低。出现两种局部炎症体征是局部和硬膜外导管感染的有力预测指标。
