Absence of bacterial growth in the culture from the epidural catheter of a patient with endometrial carcinoma and febrile neutropenia: a case report and review of the literature

Infection is a potentially serious complication of long-term epidural (EP) catheterization in cancer patients. Although the use of epidural opioid analgesia is an effective and safe means for pain relief in terminally ill patients, these patients are in need of monitorization for possible infection. This is the first report in which EP catheter cultivation has been assessed in an immunocompromised and febrile neutropenic endometrial cancer patient.

Epidural analgesia; Epidural infection; Cancer; Febrile neutropenia

[1] Portenoy R. K.,M iransky J.. ThalerH . T. et al.: "Pain in ambulatory patients with lung and colon cancer. Prevelence and characteristics". Cancer, 1992, 70, 1616.

[2] Sutton I. R., Cousins M. J.: "Anesthetic techniques for pam control". In: Portenoy RK, Kanner RM (eds). Pain Management Theory and Practice. Philadelphia, Davis, 1996, 277.

[3] Portenoy R. K.: "Opioid analgesics". In: Portenoy RK, Kanner RM (eds). Pain Management: Theory and Practice. Philadelphia, Davis, 1996, 248.

[4] Bengstsson M., Nettelblad H., Sjoberg F.: "Extradural catheterrelated infections in patients with infected cutaneous wounds". Br. J. Anaesth., 1997, 79, 668.

[5] Du Pen S. L.,P eterson D. G.,W illiams A.,B ogosian A. J.: "lnfection during chronic epidural catheterization: Diagnosis and treatment". Anesthesiology, 1990, 73, 905.

[6] Fujimoto T.: "Antibiotic therapy of acute infection in patients with cancer". Gan To Kagaku Ryoho, I 986, 13, 2914.

[7] Smitt P. S.,T satka A.,B ent M. van den,B ruinH . de et al.: "Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging". Neural,1999, 246, 815.

[8] Twycross R.: "Opioids". In Textbook of Pain. Wall PD, Melzack R.(eds.) 4th edition,H ong Kong,C huchill Livingstone, 1999, 1187.

[9] Barreto R. S.: "Bacteriological cultures of indwelling epidural catheters". Anesthesiology, 1962, 23, 643.

[10] Fine P. G., Bradford H. D., Zahniser J. C.: "Epidural abscess flowing epidural catheterization in a chronic pain patient. A diagnostic dilemma". Anesthesiology, 1988, 69, 422.

[11] Darouiche R. 0.,H amill R. J., Greenberg S. B., Weathers S. W., Musher D. M.: "Bacterial spinal epidural abscess. Review of 43 cases and literature". Rev. Infect. Dis.,1992, 71, 369.

[12] Hlavin M. L., Kaminski H. J., Ross J. S., Gan z E.: "Spinal epidu ral abscess: a ten-year prospective". Neurosurgerv, 1990, 27, 177.

[13] Britt R.H.. Enzmann D. R.: "Clinical stages of human brain abscesses on serial CT scans after contrast infusion. Computerized tomographic,n europathological,a nd clinical correlations". J. Neurosurg, 1983, 59, 972.

[14] Nitescu P., Sjoberg M., Appelgren L., Curelaru I.: "Complications of intrathecal opioids and bupivacaine in the treatment of "refractory" cancer pain". Clin. J. Pain., 1995, 11, 45.

[15] Sherertz R. J., Carruth W. A., Marosok R. D. etal.: "Contribution of vascular catheter material to the pathogenesis of infection: the enhanced risk of silicone in vivo". J. Biomed. Mater. Res., 1995, 29, 635.

[16] Cooper G. L., Roberts J. T., O'Brien A. et al.: "Microbial exami-nation of kidney lithotripter tub water and epidural anesthesia catheters". Infection Control, 1986, 7, 216.

[17] Nickels J. H., Poulos J. G., Chaouki K.: "Risk of infection from short term epidural catheter use". Reg. Anesth., 1989, 14, 88.

[18] Sakuragi T., Tshino H., Dan I. C.: "Bactericidal activity of clinically used local anesthetics on Staphylococcus aureus". Regional Anaesthesia, 1996, 21, 239.