Comparative study of microbial colonization of catheters for prolonged regional anesthesia when using different fixation methods

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Abstract

BACKGROUND: Infectious complications related to prolonged epidural and peripheral regional anesthesia are quite rare. However, this does not exclude the necessity of strict adherence to measures aimed at preventing microbial colonization of catheters for regional anesthesia. Microbial colonization of the catheter is not always accompanied by the development of infectious complications but increases the likelihood of their occurrence.

AIM: To determine the frequency of colonization, the qualitative and quantitative composition of the microflora depending on the various methods of fixing of the catheter and the duration of its use.

MATERIALS AND METHODS: 76 patients from 2 to 18 years old with prolonged epidural or peripheral anesthesia were included in an comparative, prospective, randomized, single-center study. Patients were divided into the groups according to the method of catheter fixation - adhesive sticker (AS), adhesive sticker and antimicrobial coating Desitol B (AS+D) and tunneling (T). Determination of microbial contamination of catheters was carried out using classical bacteriological studies.

RESULTS: None of the 76 patients had signs of a local or systemic infection. The difference in the frequency of colonization between the AS and T groups was statistically significant: χ2 (1, n = 54) = 5.5381 (p = 0.018), between the AS and AS+D groups it was not significant. The relative risk of colonization of the skin of the catheter with adhesive fixation was 2.14 times higher than with catheter tunneling: RR = 2.14, p = 0.05 (95% CI 1.0–4.49). In the AS+D group, colonization of both the skin and the inner part of the catheter was observed significantly earlier than in the T group: skin part: U = 5.5; Ucr = 8 (p = 0.02); inner part: U = 5.5; Ucr = 6 (p = 0.04). The growth of Staphylococcus epidermidis (48.3%) and Staphylococcus aureus (20.7%) was fixed mainly when positive results of microbiological culture takes place.

CONCLUSIONS: Tunneling is the preferred method of fixation of the catheter when the postoperative pain relief period is more than 3 days.

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About the authors

Ekaterina S. Yakovleva

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Author for correspondence.
Email: anemonfish@gmail.com

MD, PhD, Department of Anesthesiology and Intensive Care

Russian Federation, Moscow

Andrey V. Diordiev

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Email: avddoc@mail.ru

MD, PhD, Dr. Sci. (Med.), Professor, Head of the Department of Anesthesiology and Intensive Care

Russian Federation, Moscow

Elena A. Adkina

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Email: ad_el@rambler.ru

MD, PhD, Anesthesiologist, Department of Anesthesiology and Intensive Care

Russian Federation, Moscow

Roman V. Shagurin

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Email: anemonfish@gmail.com

Anesthesiologist, Department of Anesthesiology and Intensive Care

Russian Federation, Moscow

Sergey V. Yakovlev

Sechenov First Moscow State Medical University

Email: anemonfish@gmail.com

MD, PhD, Dr. Sci. (Med.), Professor, Department of Hospital Therapy

Russian Federation, Moscow

Yuliya M. Kulagina

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Email: anemonfish@gmail.com

Head of Сlinical Diagnostic Laboratory

Russian Federation, Moscow

Nadezhda A. Golovinskaya

Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health

Email: anemonfish@gmail.com

bacteriologist, Сlinical Diagnostic Laboratory

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Catheter tunneling

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2. Fig. 2. Tunneled catheter after tightening the loop

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3. Fig. 3. Growth rates of microflora on the outer part of the catheter

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4. Fig. 4. Growth rates of microflora on the inner part of the catheter

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5. Fig. 5. Results of bacteriological examination of microflora with positive results of bacteriological analysis

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