Infections Complicating Tunneled Intraspinal Catheter Systems Used to Treat Chronic Pain
Tunneled intraspinal catheters and catheter-pump systems are increasingly common treatments for severe chronic pain, but these long-term catheters have caused meningitis, epidural abscesses, and other serious infections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-y...
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| Veröffentlicht in: | Clinical infectious diseases 1995-08, Vol.21 (2), p.403-408 |
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| creator | Byers, Karin Axelrod, Peter Michael, Susan Rosen, Steven |
| description | Tunneled intraspinal catheters and catheter-pump systems are increasingly common treatments for severe chronic pain, but these long-term catheters have caused meningitis, epidural abscesses, and other serious infections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated infections: two were meningeal (one was accompanied by an epidural abscess and one by a pocket infection and bacteremia), four were associated with a pocket, and one was associated with a tunnel. The infection rate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were isolated were primarily normal skin flora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at least 100 minutes (RR, 8.8; 95% CI, 1.6–50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone. Considering the severity of illness in catheter recipients, the infection rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CNS, the infecting organism has an intrinsically low virulence, and the infected patient is terminally ill. |
| doi_str_mv | 10.1093/clinids/21.2.403 |
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At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated infections: two were meningeal (one was accompanied by an epidural abscess and one by a pocket infection and bacteremia), four were associated with a pocket, and one was associated with a tunnel. The infection rate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were isolated were primarily normal skin flora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at least 100 minutes (RR, 8.8; 95% CI, 1.6–50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone. Considering the severity of illness in catheter recipients, the infection rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CNS, the infecting organism has an intrinsically low virulence, and the infected patient is terminally ill.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/clinids/21.2.403</identifier><identifier>PMID: 8562751</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Abscess - etiology ; Abscess - microbiology ; Adult ; Aged ; Aged, 80 and over ; Analgesia, Epidural ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Antibiotics ; Bacteremia - etiology ; Bacteremia - microbiology ; Bacteria - isolation & purification ; Bacterial Infections - etiology ; Bacterial Infections - microbiology ; Biological and medical sciences ; Catheters ; Catheters, Indwelling - adverse effects ; Chronic Disease ; Chronic pain ; Clinical Articles ; Cohort Studies ; Female ; Humans ; Indwelling catheters ; Infections ; Infusion Pumps, Implantable - adverse effects ; Local anesthesia. Pain (treatment) ; Male ; Medical sciences ; Meningitis, Bacterial - etiology ; Meningitis, Bacterial - microbiology ; Middle Aged ; Morphine ; Neoplasms - complications ; Pain ; Pain - etiology ; Pain Management ; Pumps ; Retrospective Studies ; Risk Factors ; Tunnels</subject><ispartof>Clinical infectious diseases, 1995-08, Vol.21 (2), p.403-408</ispartof><rights>Copyright 1995 The University of Chicago</rights><rights>1995 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c382t-55cfb59c1b0396bf20a73a0e91f8e65dbb836138aa25e8fc2f63586eabe9a3423</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4458796$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4458796$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3614279$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8562751$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Byers, Karin</creatorcontrib><creatorcontrib>Axelrod, Peter</creatorcontrib><creatorcontrib>Michael, Susan</creatorcontrib><creatorcontrib>Rosen, Steven</creatorcontrib><title>Infections Complicating Tunneled Intraspinal Catheter Systems Used to Treat Chronic Pain</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><description>Tunneled intraspinal catheters and catheter-pump systems are increasingly common treatments for severe chronic pain, but these long-term catheters have caused meningitis, epidural abscesses, and other serious infections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated infections: two were meningeal (one was accompanied by an epidural abscess and one by a pocket infection and bacteremia), four were associated with a pocket, and one was associated with a tunnel. The infection rate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were isolated were primarily normal skin flora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at least 100 minutes (RR, 8.8; 95% CI, 1.6–50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone. Considering the severity of illness in catheter recipients, the infection rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CNS, the infecting organism has an intrinsically low virulence, and the infected patient is terminally ill.</description><subject>Abscess - etiology</subject><subject>Abscess - microbiology</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analgesia, Epidural</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Antibiotics</subject><subject>Bacteremia - etiology</subject><subject>Bacteremia - microbiology</subject><subject>Bacteria - isolation & purification</subject><subject>Bacterial Infections - etiology</subject><subject>Bacterial Infections - microbiology</subject><subject>Biological and medical sciences</subject><subject>Catheters</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Chronic Disease</subject><subject>Chronic pain</subject><subject>Clinical Articles</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Indwelling catheters</subject><subject>Infections</subject><subject>Infusion Pumps, Implantable - adverse effects</subject><subject>Local anesthesia. Pain (treatment)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meningitis, Bacterial - etiology</subject><subject>Meningitis, Bacterial - microbiology</subject><subject>Middle Aged</subject><subject>Morphine</subject><subject>Neoplasms - complications</subject><subject>Pain</subject><subject>Pain - etiology</subject><subject>Pain Management</subject><subject>Pumps</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Tunnels</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1995</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kM9rFDEUgIMota3ePSjkIN5mmx-TH3OUQe1CUeluoXgJb7KJTZ3JrEkW7H_fyA57yoPve4_wIfSOkhUlHb-yY4hhl68YXbFVS_gLdE4FV40UHX1ZZyJ002quX6OLnB8JoVQTcYbOtJBMCXqO7tfRO1vCHDPu52k_BgslxN94e4jRjW6H17EkyPsQYcQ9lAdXXMKbp1zclPFdrkaZ8TY5KLh_SHMMFv-EEN-gVx7G7N4u7yW6-_pl2183Nz--rfvPN43lmpVGCOsH0Vk6EN7JwTMCigNxHfXaSbEbBs0l5RqACae9ZV5yoaWDwXXAW8Yv0afj3X2a_x5cLmYK2bpxhOjmQzZK1R6EiyqSo2jTnHNy3uxTmCA9GUrM_5hmiWkYNczUmHXlw3L7MExud1pY6lX-ceGQLYw-QbQhn7T68Zaprmrvj9pjLnM64bYVWnWy4uaIQ23674Qh_TFScSXM9f0vs2lvN9_bjTC3_Bnpn5fq</recordid><startdate>19950801</startdate><enddate>19950801</enddate><creator>Byers, Karin</creator><creator>Axelrod, Peter</creator><creator>Michael, Susan</creator><creator>Rosen, Steven</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19950801</creationdate><title>Infections Complicating Tunneled Intraspinal Catheter Systems Used to Treat Chronic Pain</title><author>Byers, Karin ; Axelrod, Peter ; Michael, Susan ; Rosen, Steven</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c382t-55cfb59c1b0396bf20a73a0e91f8e65dbb836138aa25e8fc2f63586eabe9a3423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1995</creationdate><topic>Abscess - etiology</topic><topic>Abscess - microbiology</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analgesia, Epidural</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Antibiotics</topic><topic>Bacteremia - etiology</topic><topic>Bacteremia - microbiology</topic><topic>Bacteria - isolation & purification</topic><topic>Bacterial Infections - etiology</topic><topic>Bacterial Infections - microbiology</topic><topic>Biological and medical sciences</topic><topic>Catheters</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Chronic Disease</topic><topic>Chronic pain</topic><topic>Clinical Articles</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Indwelling catheters</topic><topic>Infections</topic><topic>Infusion Pumps, Implantable - adverse effects</topic><topic>Local anesthesia. Pain (treatment)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meningitis, Bacterial - etiology</topic><topic>Meningitis, Bacterial - microbiology</topic><topic>Middle Aged</topic><topic>Morphine</topic><topic>Neoplasms - complications</topic><topic>Pain</topic><topic>Pain - etiology</topic><topic>Pain Management</topic><topic>Pumps</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Tunnels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Byers, Karin</creatorcontrib><creatorcontrib>Axelrod, Peter</creatorcontrib><creatorcontrib>Michael, Susan</creatorcontrib><creatorcontrib>Rosen, Steven</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Byers, Karin</au><au>Axelrod, Peter</au><au>Michael, Susan</au><au>Rosen, Steven</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Infections Complicating Tunneled Intraspinal Catheter Systems Used to Treat Chronic Pain</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clinical Infectious Diseases</addtitle><date>1995-08-01</date><risdate>1995</risdate><volume>21</volume><issue>2</issue><spage>403</spage><epage>408</epage><pages>403-408</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Tunneled intraspinal catheters and catheter-pump systems are increasingly common treatments for severe chronic pain, but these long-term catheters have caused meningitis, epidural abscesses, and other serious infections. At a cancer referral center, 81 catheters were placed in 72 patients over a 7-year period. There were seven catheter-associated infections: two were meningeal (one was accompanied by an epidural abscess and one by a pocket infection and bacteremia), four were associated with a pocket, and one was associated with a tunnel. The infection rate was 0.77 per 1,000 catheter-days. Pathogenic organisms that were isolated were primarily normal skin flora. By multivariate Cox analysis, the only factor significantly associated with catheter infection was prolonged catheter placement surgery, i.e., a procedure lasting at least 100 minutes (RR, 8.8; 95% CI, 1.6–50). Three patients were cured by removal of the catheter and treatment with antibiotics, and symptoms were satisfactorily suppressed in four patients with antibiotics alone. Considering the severity of illness in catheter recipients, the infection rate was relatively low. Removal of the catheter does not appear mandatory when the goal is suppression of infection-related symptoms, especially when the infection has not spread to the CNS, the infecting organism has an intrinsically low virulence, and the infected patient is terminally ill.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>8562751</pmid><doi>10.1093/clinids/21.2.403</doi><tpages>6</tpages></addata></record> |
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| ispartof | Clinical infectious diseases, 1995-08, Vol.21 (2), p.403-408 |
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| source | Jstor Complete Legacy; MEDLINE; Oxford University Press Journals Digital Archive Legacy |
| subjects | Abscess - etiology Abscess - microbiology Adult Aged Aged, 80 and over Analgesia, Epidural Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibiotics Bacteremia - etiology Bacteremia - microbiology Bacteria - isolation & purification Bacterial Infections - etiology Bacterial Infections - microbiology Biological and medical sciences Catheters Catheters, Indwelling - adverse effects Chronic Disease Chronic pain Clinical Articles Cohort Studies Female Humans Indwelling catheters Infections Infusion Pumps, Implantable - adverse effects Local anesthesia. Pain (treatment) Male Medical sciences Meningitis, Bacterial - etiology Meningitis, Bacterial - microbiology Middle Aged Morphine Neoplasms - complications Pain Pain - etiology Pain Management Pumps Retrospective Studies Risk Factors Tunnels |
| title | Infections Complicating Tunneled Intraspinal Catheter Systems Used to Treat Chronic Pain |
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