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PubMed2002

Bacterial contamination of epidural needles after multiple skin passes.

BACKGROUND: Infection and epidural abscess are important complications of epidural analgesia. Difficult insertion may be associated with an increased risk of bacterial contamination of the epidural needle or catheter. METHODS: Bacterial contamination of epidural needles and trocars after difficult epidural insertion, defined as two or more skin passes, was assessed in 38 obstetric and ten gynaecological patients. RESULTS: There was no bacterial growth on any of the 48 epidural needles or trocars despite the mean (range) insertion time being 20 (10-30) min and the number of insertion attempts being 3 (2-4). CONCLUSIONS: Difficult epidural insertion is not associated with an increased risk of needle contamination and is therefore an unlikely source of epidural infection.

Anesthesia, Epidural↗
PubMed1999

Pseudomonas aeruginosa central nervous system infections: analysis of clinical features of 16 adult patients.

BACKGROUND: The purpose of this study was to analyze the clinical features and therapeutic outcome of 16 adult patients with Pseudomonas aeruginosa central nervous system (CNS) infection. We also attempted to identify the factors that significantly influence the prognosis of this potentially fatal CNS infection. METHODS: Sixteen adult patients with P aeruginosa CNS infection, nine men and seven women, aged from 18 to 86 years, were included in this retrospective study. The clinical features and the laboratory data of these patients were analyzed. Potential prognostic factors were compared by means of Fisher's exact test and the relative risks were estimated by odds ratio. RESULTS: Of the 16 patients, 13 had meningitis and three had focal suppuration (two with brain abscess and one with spinal epidural abscess). The 13 meningitis patients with nosocomial or community-acquired infections were classified into two forms: the spontaneous form and the neurosurgical form. The overall mortality rate was 37.5% (6/16). In the meningitis group, the patients with the neurosurgical form had a lower mortality rate (11.1%; 1/9) than the patients with the spontaneous form (100%; 4/4), and those with community-acquired meningitis had a higher mortality rate (80%; 4/5) than those with nosocomial infections (12.5%; 1/8). All the meningitis patients who did not receive appropriate antibiotic treatment expired. The statistically significant prognostic factors included the acquisition of infection, form of infection, bacteremia, initial level of consciousness and the use of appropriate antibiotics. CONCLUSIONS: Vigilance for P aeruginosa is particularly important in patients with predisposing factors such as head injury, neurosurgical procedures and long-term debilitating diseases. Early appropriate antibiotic therapy and neurosurgical intervention for patients with suppurative infections can bring about improved therapeutic results.

Adolescent↗
PubMed2003

Diffusion-weighted MR imaging in intracranial infections.

INTRODUCTION: Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is valuable in the assessment of acute cerebral infarction and may be useful for other diseases of the central nervous system (CNS). In this study, we present the DWMRI appearance of intracranial infection. MATERIALS AND METHODS: Thirty patients with clinical diagnosis of CNS infection were reviewed. All patients underwent conventional contrast-enhanced MR examination and DWMRI using single-shot echo-planar imaging at b = 1000 s/mm2. RESULTS: Cerebral abscess, tuberculoma, subdural empyema and epidural abscess were hyperintense on DWMRI. Neurocysticercosis showed hypointense lesions on DWMRI. Four of 5 patients with encephalitis showed DWMRI hyperintensity; the appearance of toxoplasmosis lesions was variable. Patients suffering from meningitis without parenchymal involvement did not exhibit any abnormality of diffusion. One patient with tuberculous meningitis developed abnormality on DWMRI from acute cerebral infarction. CONCLUSION: DWMRI increased lesion conspicuity and may be useful in assessment of cerebral infection. There were striking differences in the DWMRI appearances caused by different organisms and diseases.

Brain Abscess↗
PubMed1988

The aching head. Intracranial suppuration due to head and neck infections.

Many infections of the head and neck may progress to cause more serious suppurative complications that involve the brain and its associated structures. Because many, if not all, of these infectious diseases present as headache, it would be appropriate to discuss all these clinical entities, but because of space limitations, this article focuses on brain abscess, subdural empyema, and cranial epidural abscess. These three pyogenic infections are reviewed in relation to their causal relationship to common and important pericranial infections.

Bacterial Infections↗
PubMed1993

Another look at spinal tuberculosis.

The steady decline in tuberculosis rates in Canada has led to a certain lack of awareness of the disease. We describe 7 patients with culture proven spinal tuberculosis, seen in a teaching hospital over a 10-year period. Persistent spinal pain and local tenderness were the most frequent presenting findings. There was a mean delay in diagnosis of 5.2 (range 1-18) months from the time of presentation. Only 2 patients had active extraspinal tuberculous infection. Plain spinal radiographs were the initial diagnostic procedure of choice showing a destructive vertebral lesion in 5 of 7 patients. Computed tomography (CT) played an important role in delineating the discovertebral lesion and in demonstrating a paraspinal soft tissue infection in 6 (85%) of 7 patients: psoas abscess in 4 (2 with epidural extension), epidural abscess in one, and a neck abscess in one. Magnetic resonance imaging (MRI) in one patient enabled a more complete definition of the vertebral infection and its soft tissue extensions. Two patients were successfully treated with combination antituberculous chemotherapy alone, and 5 required adjuvant surgical procedures. Our study stresses the need for increased alertness to this now uncommon but treatable spinal infection, and emphasizes the diagnostic usefulness of CT and MRI in defining subtle discovertebral lesions and in detecting unsuspected paravertebral soft tissue extension.

Abscess↗
PubMed2003

[Unusual case of the ear cholesteatoma].

The authors present a case of temporal and occipital bone extensive destruction with epidural abscess of posterior cranial cavity and abscess of occipito-nuchal region created by giant cholesteatoma of the middle ear. There has been discussed a diagnosing troubles as well as performed surgical treatment.

Adult↗
PubMed1998

Bacterial colonization and infection rate of continuous epidural catheters in children.

UNLABELLED: Continuous epidural infusions are widely used for postoperative analgesia in children. We prospectively studied the incidence of bacterial colonization of caudal and lumbar epidural catheters, as well as the incidence of serious systemic and local infection, in 210 children after short-term epidural analgesia. Using aseptic technique, epidural catheters were inserted into either the lumbar or the caudal epidural space based on the preferences of the anesthesia team and/or clinical indication. The integrity of the catheter and overlying transparent dressing site was evaluated by a member of the pediatric pain service at least once a day. The catheters were aseptically removed if the patient had a fever greater than 39 degrees C, if the dressing was compromised, or when epidural analgesia was no longer required. The subcutaneous portion of the catheter was semiquantitatively cultured. Cellulitis (erythema, swelling, purulent discharge, pustule formation, or tenderness) was diagnosed by examination of the epidural insertion site. The mean (+/- SD) age of patients in the caudal catheter group (n = 170) was 3 +/- 3 yr; their mean weight was 13 +/- 11 kg. The mean (+/- SD) age of patients in the epidural catheter group (n = 40) was 11 +/- 4 yr; their mean weight was 36 +/- 23 kg. All catheters remained in place for 3 +/- 1 days (range 1-5 days). There was no serious systemic infection (meningitis, epidural abscess, or systemic sepsis). Of all epidural catheters, 35% (73 of 210) were colonized. Gram-positive colonization was similar in caudal (25%; 43 of 170) and lumbar (23%; 9 of 40) catheters. Gram-negative organisms were cultured from 16% of the caudal catheters (27 of 170) and 3% of the lumbar catheters (1 of 40). In patients treated with caudal epidural catheters, children aged >3 yr were less likely to have colonized epidural catheters than younger children. Age did not affect the probability of developing cellulitis at the insertion site. Although patients aged <3 yr with caudal catheters had a slightly greater risk of cellulitis than children aged >3 yr (14% vs 9%), this association was very weak (P = 0.33). We observed that, despite bacterial colonization of caudal and lumbar epidural catheters, serious systemic and local infection after short-term epidural analgesia did not occur in our study. IMPLICATIONS: Continuous epidural infusions are widely used for postoperative analgesia in children. We found no serious systemic infections after short-term (3 days) continuous epidural analgesia in children.

Abscess↗
PubMed2001

A Staphylococcus aureus paraspinal abscess associated with epidural analgesia in labour.

A case is described in which a parturient developed a Staphylococcus aureus paraspinal abscess following epidural analgesia in labour. We compared this case with other reported cases of paraspinal abscesses in obstetric patients. The presentation, diagnosis and management of these cases were reviewed. Anaesthetists need to be aware that non-spinal-epidural abscesses can occur in patients with an associated labour epidural.

Abscess↗
PubMed1988

Epidural spinal infection in intravenous drug abusers.

The incidence of spinal epidural abscess and disk space infection appears to be rising in intravenous drug-using patients. We report 18 cases seen over three years in two municipal hospitals. Staphylococcus aureus was the most common infective agent, but two patients had Mycobacterium tuberculosis infection. Computed tomography of the spine facilitates diagnosis. Early treatment improves outcome but host factors play a role in recovery.

Abscess↗
PubMed1979

Vertebral osteomyelitis and epidural abcess due to mucormycosis, a case report.

A patient is described, with a history of pain in the neck, followed by a slowly progressive loss of muscle strength in both arms, followed by tetraplegia. Medical history included laryngectomy with partial hypopharyngectomy preceded by radiotherapy, because of carcinoma. X-ray of the cervical spine was suggestive for metastases. The patient died as a consequence of massive pulmonary embolism and at autopsy the cause of the neurological deficit turned out to be vertebral osteomyelitis and epidural abscess due to mucormycosis.

Abscess↗
PubMed2000

Neonatal infectious spondylitis of the cervical spine presenting with quadriplegia: a case report.

STUDY DESIGN: A case report.- OBJECTIVE: To highlight the evaluation and treatment of neonatal infectious spondylitis of the cervical spine. SUMMARY OF BACKGROUND DATA: Most authors advise intravenous antibiotics as first-choice treatment. The place of aspiration or operative drainage is debated, as is the position and duration of immobilization. METHODS: A 3-week-old neonate was presented with intermittent quadriplegia. RESULTS: Additional investigation demonstrated an osteolytic process in the body of C3 with a large epidural abscess compressing the spinal cord. Because an infectious spondylitis of C3 was suspected, aspiration of the abscess was performed, and antibiotic therapy was started. The patient improved to neurologically normal within 3 weeks and remains asymptomatic throughout a follow-up period of 7 years. CONCLUSIONS: Neonatal infectious spondylitis should be diagnosed early and treated promptly; otherwise, it may have devastating consequences.

Abscess↗
PubMed2003

Computed tomographic versus surgical findings in complicated acute otomastoiditis.

Computed tomography (CT) plays an important role in planning surgery in cases of complicated middle ear infection. The purpose of this study was to determine, by comparison of radiologic and surgical findings, the diagnostic value of CT in complicated acute otomastoiditis. The study group consisted of 37 patients without a history of chronic ear disease. In this study, CT enabled correct diagnosis of 26 of 27 cases (96%) of subperiosteal abscess, 17 of 18 cases (94%) of mastoid cortex erosion in patients with subperiosteal abscess, and several intracranial complications, including epidural abscess, subdural empyema, and perisinus abscess. The CT scan produced overdiagnosis in some cases: sigmoid sinus thrombosis in 1 patient, mastoid cortex erosion in 2 children with subperiosteal abscess, and bone erosion toward the posterior cranial fossa in 1 patient with meningitis. My findings suggest that subperiosteal abscess is a disease of young children; however, when it develops in an older child, cholesteatoma should be suspected. Furthermore, acute mastoiditis complicated with facial nerve paralysis may be associated with cholesteatoma in 66% of cases. My experience showed that CT had a sensitivity of 97% and a positive predictive value of 94% in the diagnosis of complicated acute otomastoiditis.

Abscess↗
PubMed1987

Tuboovarian abscess presenting as sciatic pain: case report.

The authors report the successful conservative treatment of a tuboovarian abscess in a 25-year old woman who presented with low grade fever and severe right sciatic pain. Computed tomography and ultrasonography corroborated a clinical diagnosis of tuboovarian abscess after an initial diagnosis of epidural abscess had been made. This is the first report of a tuboovarian abscess presenting principally as sciatic pain. The diagnosis and treatment of this lesion are discussed.

Abscess↗
PubMed2001

[Intracranial complications of sinusitis in the material of the Otolaryngology Department, K. Marcinkowski University of Medical Sciences in Poznań in the years 1964-1999].

In the period of 35 years 25 patients with intracranial complications of paranasal sinusitis were treated in the Department of Otolaryngology of the Karol Marcinkowski University School of Medical Sciences in Poznań. In the past 15 years the number of complications decreased annually by half. Intracranial sinusal complications were more frequently present in young men. In 25 patients abscesses of the frontal lobe and epidural abscesses were most often diagnosed. Surgical treatment was carried out in each case when the inflammation process spread into the bony parts or into intracranial space. The method of choice in treatment of frontal lobe abscess and subdural abscesses is elimination of sinuses inflammatory foci with a simultaneous evacuation of the abscess by puncturing of the abscess and gradual exchange of its content into antibiotic solution. Intensive antibiotic therapy was carried out for the period of 4 weeks. Mortality rate in our material concerned patients with the brain frontal lobe abscesses and amounted to 12%. In the last 15 years we succeeded to treat all 17 patients.

Adult↗
PubMed2003

Community-acquired spontaneous bacterial meningitis in patients with alcoholic liver disease.

BACKGROUND AND PURPOSE: Data on the clinical characteristics of adult alcoholic liver disease (ALD) patients with acute bacterial meningitis is limited. This study analyzed the clinical and laboratory data and therapeutic outcome of 14 men with ALD treated over a 15-year period. METHODS: Standardized forms were used to collect data from medical records of all adult patients with bacterial meningitis admitted to Chang Gung Memorial Hospital-Kaohsiung from January 1986 to December 2000. Data collected included microbiological records for cerebrospinal fluid, blood cultures, and all medical records. RESULTS: Three of the 14 patients with ALD had liver cirrhosis (2 with Child's class B and 1 with Child's class C). The causative pathogens of these 14 cases were Klebsiella pneumoniae in 11, Staphylococcus aureus in 2 and Enterococcus in 1. Diabetes mellitus (DM) was the most common underlying disease and was present in 64% of patients (9/14). All patients with DM had K. pneumoniae as the causative pathogen. Bacteremia and thrombocytopenia were found in 64% (9/14) and 50% (7/14) of the patients, respectively. Focal suppurations including brain abscess, intracranial subdural empyema, and cervical epidural abscess were found in 4 patients. The overall mortality rate was 14% (2/14). ALD accounted for 11.5% (14/122) of the underlying conditions of all adult cases of community-acquired spontaneous bacterial meningitis treated during the study period. CONCLUSIONS: There was a high incidence of K. pneumoniae infection in adult meningitis patients with ALD, especially those with concomitant DM.

Adult↗
PubMed1989

Central nervous system infections in the elderly.

Review of records of patients aged 65 years and older admitted to The Mount Sinai Hospital, New York, NY, during the period from 1970 through 1985 revealed 57 episodes of central nervous system infections, including 50 meningitides, 5 brain abscesses, 1 subdural empyema, and 1 epidural abscess. Predisposing conditions were present in 17 patients with meningitis, and concurrent infections occurred in 19 patients. Streptococcus pneumoniae accounted for 43% of all isolates; 25% were gram-negative organisms. Of the patients in this sample, fever was present in 100%, meningismus was present in 58%, and change in mental status was present in 86%. Sixty-five percent of patients with meningitis survived; increased mortality was associated with altered mental status, inappropriate initial antibiotic therapy, and hypoglycorrhachia. Delay in diagnosis, underlying disease, and bacteremia did not significantly alter outcome. All patients with focal infections presented with localizing signs and all survived.

Aged↗
PubMed1989

[Spinal subdural abscess--report of a case and a review of the literature of 43 cases].

Spinal subdural abscess is rare, compared with spinal epidural abscess. The first case was reported by Sittig in 1927. Only 43 cases have been reported throughout the literature. We experienced an atypical fulminant case of spinal subdural abscess, following the operation for intracranial aneurysms. The patient was a 48-year-old male, admitted to our hospital on April 9, 1987 with complaining of sudden headache and vomiting. A lumbar puncture proved subarachnoid hemorrhage (S.A.H.), CT scan revealed saccular aneurysms in left middle cerebral artery and left internal carotid-ophthalmic artery. Radical surgical treatment for those aneurysms was undergone successfully. Neither cerebral ventricular nor cisternal drainage was established. His postoperative course was uneventful until the 9th postoperative day. He suddenly complained of pain in his legs and back, followed by paraplegia, respiratory, and cardiac arrests with clinical course of several hours. Antibiotics had been used for eight days after surgery, and there was no clinical evidence of inflammation sign. For his abrupt aggravation, a spinal infarction was suspected. However, the autopsy demonstrated that the dorsal side of the entire spinal cord was covered with masses of pus, and central necrosis and hemorrhage of the spinal cord mainly occupied the central gray matter; so-called Pencilsharped softening. In this case, the cause of spinal subdural abscess was unclear. But the lumbar puncture performed on the day of admission, was most responsible. Also, the reasons why the clinical course of our case was rapid and fulminant were discussed with preference of spinal abscess to primary spinal circular disorder. 44 cases in the literature, including the presented report, was reviewed. Those symptomatology, predisposing factors, pathogenesis, the extent of spinal subdural abscess, clinical diagnosis, treatment, and prognosis were discussed. Among previous cases, this case was one of the most extensive subdural abscess and fulminant clinical course.

Acute Disease↗