Is postoperative intrathecal catheter use associated with central nervous system infection?

Abstract

Background: Continuation of intrathecal anesthesia into the postoperative period has been limited by important safety concerns. Principal among these has been the assumption that extended intrathecal therapy leads to spinal (epidural and intrathecal) space infections. To address the role of extended intrathecal catheter therapy as a cause of infections, we cultured all intrathecal catheters used to provide postoperative analgesia. Methods: All intrathecal catheters were inserted in the operating room using sterile technique. The catheters were used either for the duration of the patients stay in the intensive care unit or until they were no longer judged to provide a therapeutic advantage. They were removed without skin preparation. The distal 2-3 cm of the catheters was cultured using semiquantitative culture methods. Results were divided into four groups: group 1, negative culture results; group 2, ten or fewer colonies of growth; group 3, more than 10 colonies on initial plates and/or growth from broth cultures; and group 4, any bacterial growth, along with evidence of local or central nervous system infections. Results: Cultures were obtained from 139 patients with a mean indwelling catheter time of 66.1 h. Group 1 (102 patients) had a mean indwelling duration of 55 h. Group 2 (26 patients) and group 3 (11 patients) had significantly longer indwelling duration (83.2 h P = .0023, 129.6 h P =