Regional Anesthesia and Infection

  • Terese T. Horlocker
  • Denise J. Wedel


Infectious complications may occur after any regional anesthetic techniques, but are of greatest concern if the infection occurs around the spinal cord or within the spinal canal. Possible risk factors include underlying sepsis, diabetes, depressed immune status, steroid therapy, localized bacterial colonization or infection, and chronic catheter maintenance. Bacterial infection of the central neural axis may present as meningitis or cord compression secondary to abscess formation. The infectious source for meningitis and epidural abscess may result from distant colonization or localized infection with subsequent hematogenous spread and central nervous system (CNS) invasion. The anesthetist may also transmit microorganisms directly into the CNS by needle/catheter contamination through a break in aseptic technique or passage through a contiguous infection. An indwelling neuraxial catheter, although aseptically sited, may be colonized with skin flora and consequently serve as a source for ascending infection to the epidural or intrathecal space.


Lumbar Puncture Spinal Anesthesia Bacterial Meningitis Epidural Analgesia Regional Anesthesia 
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  1. 1.
    Ready LB, Helfer D. Bacterial meningitis in parturients after epidural anesthesia. Anesthesiology 1989;71:988–990.PubMedCrossRefGoogle Scholar
  2. 2.
    Baker AS, Ojemann RG, Swartz MN, Richardson EP. Spinal epidural abscess. N Engl J Med 1975;293:463–468.PubMedCrossRefGoogle Scholar
  3. 3.
    Ericsson M, Algers G, Schliamser SE. Spinal epidural abscesses in adults: review and report of iatrogenic cases. Scand J Infect Dis 1990;22:249–257.PubMedCrossRefGoogle Scholar
  4. 4.
    Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. Anesthesiology 2004;101:950–959.PubMedCrossRefGoogle Scholar
  5. 5.
    Wang LP, Hauerberg J, Schmidt JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. Anesthesiology 1999;91:1928–1936.PubMedCrossRefGoogle Scholar
  6. 6.
    Kilpatrick ME, Girgis NI. Meningitis — a complication of spinal anesthesia. Anesth Analg 1983;62:513–515.PubMedCrossRefGoogle Scholar
  7. 7.
    Rüssel NA, Vaughan R, Morley TP. Spinal epidural infection. Can J Neurol Sci 1979;6: 325–328.Google Scholar
  8. 8.
    Danner RL, Hartman BJ. Update of spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis 1987;9:265–274.PubMedCrossRefGoogle Scholar
  9. 9.
    Du Pen SL, Peterson DG, Williams A, Bogosian AJ. Infection during chronic epidural catheterization: diagnosis and treatment. Anesthesiology 1990;73:905–909.PubMedCrossRefGoogle Scholar
  10. 10.
    Scott DB, Hibbard BM. Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth 1990;64:537–541.PubMedCrossRefGoogle Scholar
  11. 11.
    Bader AM, Datta S, Gilbertson L, Kirz L. Regional anesthesia in women with chorioamnionitis. Reg Anesth 1992;17:84–86.PubMedGoogle Scholar
  12. 12.
    Strafford MA, Wilder RT, Berde CB. The risk of infection from epidural analgesia in children: a review of 1620 cases. Anesth Analg 1995;80:234–238.Google Scholar
  13. 13.
    Goodman EJ, DeHorta E, Taguiam JM. Safety of spinal and epidural anesthesia in parturients with chorioamnionitis. Reg Anesth 1996;21:436–441PubMedGoogle Scholar
  14. 14.
    Dahlgren N, Tornebrandt K. Neurological complications after anaesthesia. A follow-up of 18,000 spinal and epidural anaesthetics performed over three years. Acta Anaesthesiol Scand 1995;39:872–880.PubMedCrossRefGoogle Scholar
  15. 15.
    Kindler C, Seeberger M, Siegemund M, Schneider M. Extradural abscess complicating lumbar extradural anaesthesia and analgesia in an obstetric patient. Acta Anaesthesiol Scand 1996;40:858–861.PubMedCrossRefGoogle Scholar
  16. 16.
    Auroy Y, Narchi P, Messiah A, Litt L, Rouvier B, Samii K. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology 1997;87: 479–486.PubMedCrossRefGoogle Scholar
  17. 17.
    Aromaa U, Lahdensuu M, Cozanitis DA. Severe complications associated with epidural and spinal anaesthetics in Finland 1987–1993. A study based on patient insurance claims. Acta Anaesthesiol Scand 1997;41:445–452.PubMedCrossRefGoogle Scholar
  18. 18.
    Kane RE. Neurologic deficits following epidural or spinal anesthesia. Anesth Analg 1981; 60:150–161.PubMedCrossRefGoogle Scholar
  19. 19.
    Videira RL, Ruiz-Neto PP, Brandao Neto M. Post spinal meningitis and asepsis. Acta Anaesthesiol Scand 2002;46:639–646.PubMedCrossRefGoogle Scholar
  20. 20.
    Schneeberger PM, Janssen M, Voss A. Alpha-hemolytic streptococci: a major pathogen of iatrogenic meningitis following lumbar puncture. Case reports and a review of the literature. Infection 1996;24:29–35.PubMedCrossRefGoogle Scholar
  21. 21.
    Trautmann M, Lepper PM, Schmitz FJ. Three cases of bacterial meningitis after spinal and epidural anesthesia. Eur J Clin Microbiol Infect Dis 2002;21:43–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Couzigou C, Vuong TK, Botherel AH, Aggoune M, Astagneau P. Iatrogenic Streptococcus salivarius meningitis after spinal anaesthesia: need for strict application of standard precautions. J Hosp Infect 2003;53:313–314.PubMedCrossRefGoogle Scholar
  23. 23.
    Rathmell JP. Infectious risks of chronic pain treatments. Reg Anesth Pain Med 2006; 31(4):346–352.PubMedGoogle Scholar
  24. 24.
    Bajwa ZH, Ho C, Grush A, Kleefield J, Warfield CA. Discitis associated with pregnancy and spinal anesthesia. Anesth Analg 2002;94:415–416.PubMedGoogle Scholar
  25. 25.
    Capdevila X, Pirat P, Bringuier S, et al. Continuous peripheral nerve blocks in hospital wards after orthopedic surgery. Anesthesiology 2005;103:1035–1045.PubMedCrossRefGoogle Scholar
  26. 26.
    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;93:1045–1049.PubMedCrossRefGoogle Scholar
  27. 27.
    Wegeforth P, Latham JR. Lumbar puncture as a factor in the causation of meningitis. Am J Med Sci 1919;158:183–202.CrossRefGoogle Scholar
  28. 28.
    Pray LG. Lumbar puncture as a factor in the pathogenesis of meningitis. Am J Dis Child 1941;295:62–68.Google Scholar
  29. 29.
    Eng RHK, Seligman SJ. Lumbar puncture-induced meningitis. JAMA 1981;245: 1456–1459.PubMedCrossRefGoogle Scholar
  30. 30.
    Teele DW, Dashefsky B, Rakusan T, Klein JO. Meningitis after lumbar puncture in children with bacteremia. N Engl J Med 1981;304:1079–1081.CrossRefGoogle Scholar
  31. 31.
    Smith KM, Deddish RB, Ogata ES. Meningitis associated with serial lumbar punctures and post-hemorrhagic hydrocephalus. J Pediatr 1986;109:1057–1060.PubMedCrossRefGoogle Scholar
  32. 32.
    Weed LH, Wegeforth P, Ayer JB, Felton LD. The production of meningitis by release of cerebrospinal fluid during an experimental septicemia. JAMA 1919;72:190–193.Google Scholar
  33. 33.
    Carp H, Bailey S. The association between meningitis and dural puncture in bacteremic rats. Anesthesiology 1992;76:739–742.PubMedCrossRefGoogle Scholar
  34. 34.
    Berman RS, Eisele JH. Bacteremia, spinal anesthesia, and development of meningitis. Anesthesiology 1978;48:376–377.PubMedCrossRefGoogle Scholar
  35. 35.
    Shintani S, Tanaka H, Irifune A, et al. Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings. Clin Neurol Neurosurg 1992;94:253–255.PubMedCrossRefGoogle Scholar
  36. 36.
    Darchy B, Forceville X, Bavoux E, Soriot F, Domart Y. Clinical and bactériologie survey of epidural analgesia in patients in the intensive care unit. Anesthesiology 1996;85: 988–998.PubMedCrossRefGoogle Scholar
  37. 37.
    Feldman J M, Chapin-Robertson K, Turner J. Do agents used for epidural analgesia have antimicrobial properties? Reg Anesth 1994;19:43–47.PubMedGoogle Scholar
  38. 38.
    James FM III, George RH, Naiem H, White GJ. Bacteriologie aspects of epidural analgesia. Anesth Analg 1976;55:187–190.PubMedCrossRefGoogle Scholar
  39. 39.
    Hunt JR, Rigor BM, Collins JR. The potential for contamination of continuous epidural catheters. Anesth Analg 1977;56:222–224.PubMedCrossRefGoogle Scholar
  40. 40.
    Barreto RS. Bacteriologie culture of indwelling epidural catheters. Anesthesiology 1962; 23:643–646.PubMedCrossRefGoogle Scholar
  41. 41.
    De Cicco M, Matovic M, Castellani GT, et al. Time-dependent efficacy of bacterial filters and infection risk in long-term epidural catheterization. Anesthesiology 1995;82: 765–771.PubMedCrossRefGoogle Scholar
  42. 42.
    Abouleish E, Amortegui AJ, Taylor FH. Are bacterial filters needed in continuous epidural analgesia for obstetrics? Anesthesiology 1977;46:351–354.PubMedCrossRefGoogle Scholar
  43. 43.
    Langevin PB, Gravenstein N, Langevin SO, Gulig PA. Epidural catheter reconnection: safe and unsafe practice. Anesthesiology 1996;85:883–888.PubMedCrossRefGoogle Scholar
  44. 44.
    Mahendru V, Bacon DR, Lema MJ. Multiple epidural abscesses and spinal anesthesia in a diabetic patient. Case report. Reg Anesth 1994;19:66–68.Google Scholar
  45. 45.
    Strong WE. Epidural abscess associated with epidural catheterization: a rare event? Report of two cases with markedly delayed presentation. Anesthesiology 1991;74:943–946.PubMedCrossRefGoogle Scholar
  46. 46.
    Huang RC, Shapiro GS, Lim M, Sandhu HS, Lutz GE, Herzog RJ. Cervical epidural abscess after epidural steroid injection. Spine 2004;29:E7–E9.PubMedCrossRefGoogle Scholar
  47. 47.
    Bader AM, Camann WR, Datta S. Anesthesia for cesarean delivery in patients with herpes simplex virus type-2 infections. Reg Anesth 1990;15:261–263.PubMedGoogle Scholar
  48. 48.
    Crosby ET, Halpern SH, Rolbin SH. Epidural anaesthesia for caesarean section in patients with active recurrent genital herpes simplex infections: a retrospective review. Can J Anaesth 1989;36:701–704.PubMedCrossRefGoogle Scholar
  49. 49.
    Ramanathan S, Sheth R, Turndorf H. Anesthesia for cesarean section in patients with genital herpes infections: a retrospective study. Anesthesiology 1986;64:807–809.PubMedCrossRefGoogle Scholar
  50. 50.
    Crone LL, Conly JM, Storgard C, et al. Herpes labialis in parturients receiving epidural morphine after cesarean section. Anesthesiology 1990;73:208–213.PubMedCrossRefGoogle Scholar
  51. 51.
    Valley MA, Bourke DL, McKenzie AM. Recurrence of thoracic and labial herpes simplex virus infection in a patient receiving epidural fentanyl. Anesthesiology 1992;76:1056–1057.PubMedCrossRefGoogle Scholar
  52. 52.
    Hughes SC, Dailey PA, Landers D, Dattel BJ, Crombleholme WR, Johnson JL. Parturients infected with human immunodeficiency virus and regional anesthesia. Anesthesiology 1995;82:32–37.PubMedCrossRefGoogle Scholar
  53. 53.
    Avidan MS, Groves P, Blott M, et al. Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy. Anesthesiology 2002;97:320–324.PubMedCrossRefGoogle Scholar
  54. 54.
    Bremerich DH, Ahr A, Buchner S, et al. Anesthetic regimen for HIV positive parturients undergoing elective cesarean section [German]. Anaesthesist 2003;52:1124–1131.PubMedCrossRefGoogle Scholar
  55. 55.
    Tom DJ, Gulevich SJ, Shapiro HM, Heaton RK, Grant I. Epidural blood patch in the HIV-positive patient. Anesthesiology 1992;76:943–947.PubMedCrossRefGoogle Scholar
  56. 56.
    Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med 2006;31(4):311–323.PubMedGoogle Scholar
  57. 57.
    Saloojee H, Steenhoff A. The health professional’s role in preventing nosocomial infections. Postgrad Med J 2001;77:16–19.PubMedCrossRefGoogle Scholar
  58. 58.
    Molinier S, Paris JF, Brisou P, Amah Y, Morand JJ, Alla P, Carli P. Two cases of iatrogenic oral streptococcal infection: meningitis and spondylodiscitis [French]. Rev Med Int 1998; 19:568–570.CrossRefGoogle Scholar
  59. 59.
    Kinirons B, Mimoz O, Lafendi L, Naas T, Meunier J, Nordmann P. Chlorhexidine versus povidone iodine in preventing colonization of continuous epidural catheters in children: a randomized, controlled trial. Anesthesiology 2001;94:239–244.PubMedCrossRefGoogle Scholar
  60. 60.
    Birnbach DJ, Stein DJ, Murray O, Thys DM, Sordillo EM. Povidone iodine and skin disinfection before initiation of epidural anesthesia. Anesthesiology 1998;88:668–672.PubMedCrossRefGoogle Scholar
  61. 61.
    Borgeat A, Ekatodramis G, Kalberer F, Benz C. Acute and nonacute complications associated with interscalene block and shoulder surgery: a prospective study. Anesthesiology 2001;95:875–880.PubMedCrossRefGoogle Scholar
  62. 62.
    Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–278.PubMedCrossRefGoogle Scholar
  63. 63.
    Bergman BD, Hebl JR, Kent J, Horlocker TT. Neurologic complications of 405 consecutive continuous axillary catheters. Anesth Analg 2003;96:247–252.PubMedGoogle Scholar
  64. 64.
    Petersdorf RG, Swarner DR, Garcia M. Studies on the pathogenesis of meningitis. II. Development of meningitis during pneumococcal bacteremia. J Clin Invest 1962;41:320–327.PubMedCrossRefGoogle Scholar
  65. 65.
    Chestnut DH. Spinal anesthesia in the febrile patient. Anesthesiology 1992;76:667–669.PubMedCrossRefGoogle Scholar
  66. 66.
    McNeely JK, Trentadue NC, Rusy LM, Farber NE. Culture of bacteria from lumbar and caudal epidural catheters used for postoperative analgesia in children. Reg Anesth 1997;22:428–431.PubMedCrossRefGoogle Scholar
  67. 67.
    Kost-Byerly S, Tobin JR, Greenberg RS, Billett C, Zahurak M, Yaster M. Bacterial colonization and infection rate of continuous epidural catheters in children. Anesth Analg 1998;86:712–716.PubMedGoogle Scholar
  68. 68.
    Mamourian AC, Dickman CA, Drayer BP, Sonntag VKH. Spinal epidural abscess: three cases following spinal epidural injection demonstrated with magnetic resonance imaging. Anesthesiology 1993;78:204–207.PubMedCrossRefGoogle Scholar
  69. 69.
    Curling OD, Gower DJ, McWhorter JM. Changing concepts of spinal epidural abscess: a report of 29 cases. Neurosurgery 1990;27:185–192.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Terese T. Horlocker
    • 1
  • Denise J. Wedel
    • 1
  1. 1.Department of AnesthesiologyMayo Clinic College of MedicineRochesterUSA

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