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Comparative study of microbial colonization of catheters for prolonged regional anesthesia when using different fixation methods
- Authors: Yakovleva E.S.1, Diordiev A.V.1, Adkina E.A.1, Shagurin R.V.1, Yakovlev S.V.2, Kulagina Y.M.1, Golovinskaya N.A.1
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Affiliations:
- Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health
- Sechenov First Moscow State Medical University
- Issue: Vol 13, No 4 (2022)
- Pages: 41-52
- Section: Original studies
- URL: https://journals.eco-vector.com/pediatr/article/view/114928
- DOI: https://doi.org/10.17816/PED13441-52
- ID: 114928
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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, MoscowAndrey 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, MoscowElena 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, MoscowRoman 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, MoscowSergey V. Yakovlev
Sechenov First Moscow State Medical University
Email: anemonfish@gmail.com
MD, PhD, Dr. Sci. (Med.), Professor, Department of Hospital Therapy
Russian Federation, MoscowYuliya 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, MoscowNadezhda A. Golovinskaya
Research and Clinical Center of Pediatric Psychoneurology Moscow Department of Public Health
Email: anemonfish@gmail.com
bacteriologist, Сlinical Diagnostic Laboratory
Russian Federation, MoscowReferences
- Aleksandrovich YuS, Ivanov DO, Pavlovskaya EYu, et al. Features of microbiota in newborns in critical condition at admission to the intensive care unit of a specialized hospital. Messenger of anesthesiology and resuscitation. 2022;19(2):56–63. (In Russ.) doi: 10.21292/2078-5658-2022-19-2-56-63
- Briko NI, Bozhkova SA, Brusina EB, et al. Profilaktika infektsii oblasti khirurgicheskogo vmeshatel’stva. Klinicheskie rekomendatsii. Nizhny Novgorod: Remedium Privolzh’e, 2018. 72 p. (In Russ.)
- Zabolotskii DV, Aleksandrovich YuS, Ul’rikh GEh, et al. Sosudistyi dostup. Uchebnoe posobie dlya vrachei. Saint Petersburg, 2015. (In Russ.)
- Yakovlev SV, Briko NI, Sidorenko SV, Protsenko DN. Rossiiskie klinicheskie rekomendatsii: Programma SKAT (Strategiya Kontrolya Antimikrobnoi Terapii) pri okazanii statsionarnoi meditsinskoi pomoshchi. Moscow: Pero, 2018. 156 p. (In Russ.)
- Bomberg H, Kubulus C, Herberger S, et al. Tunnelling of thoracic epidural catheters is associated with fewer catheter-related infections: a retrospective registry analysis. Br J Anaesth. 2016;116(4):546–553. doi: 10.1093/bja/aew026
- Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg. 2001;93(4):1045–1049. doi: 10.1097/00000539-200110000-00050
- Harde M, Bhadade R, Iyer H, et al. A comparative study of epidural catheter colonization and infection in Intensive Care Unit and wards in a Tertiary Care Public Hospital. Indian J Crit Care Med. 2016;20(2):109–113. doi: 10.4103/0972-5229.175943
- Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. Anesthesiology. 1999;91:1928. doi: 10.1097/00000542-199912000-00046
- Morin AM, Kerwat KM, Klotz M, et al. Risk factors for bacterial catheter colonization in regional anaesthesia. BMC Anesthesiol. 2005;5(1):1. doi: 10.1186/1471-2253-5-1
- Neuburger M, Büttner J, Blumenthal S, et al. Inflammation and infection complications of 2285 perineural catheters: a prospective study. Acta Anaesthesiol Scand. 2007;51(1):108–114. doi: 10.1111/j.1399-6576.2006.01173.x
- Nussbaum ES, Rigamonti D, Standiford H, et al. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol. 1992;38(3):225–231. doi: 10.1016/0090-3019(92)90173-k
- Ruppen W, Derry S, McQuay HJ, Moore RA. Infection rates associated with epidural indwelling catheters for seven days or longer: systematic review and meta-analysis. BMC Palliat Care. 2007;6:3. doi: 10.1186/1472-684X-6-3
- Seth N, Macqueen S, Howard RF. Clinical signs of infection during continuous postoperative epidural analgesia in children: the value of catheter tip culture. Paediatr Anaesth. 2004;14(12):996–1000. doi: 10.1111/j.1460-9592.2004.01553.x
- Stabille DM, Filho AD, Mandim BL, et al. Frequency of colonization and isolated bacteria from the tip of the epidural catheter implanted for postoperative analgesia. Rev Bras Anestesiol. 2015;65(3):200–206. (In Portug.) doi: 10.1016/j.bjan.2014.05.015
- Steffen P, Seeling W, Essig A, et al. Bacterial contamination of epidural catheters: microbiological examination of 502 epidural catheters used for postoperative analgesia. J Clin Anesth. 2004;16(2):92–97. doi: 10.1016/j.jclinane.2003.05.007
- Yentur EA, Luleci N, Topcu I, et al. Is skin disinfection with 10 % povidone iodine sufficient to prevent epidural needle and catheter contamination? Reg Anesth Pain Med. 2003;28(5):389–393. doi: 10.1016/j.rapm.2003.08.002
- Yuan H-B, Zuo Z, Yu KW, et al. Bacterial colonization of epidural catheters used for short-term postoperative analgesia: microbiological examination and risk factor analysis. Anesthesiology. 2008;108(1):130–137. doi: 10.1097/01.anes.0000296066.79547.f3
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