Regional analgesia catheter infections and the effectiveness of antibiotic prophylaxis in immunosuppressed patients: A retrospective registry analysis
Final Report Abstract
Regional analgesia catheters are commonly used to provide long-lasting pain relief after surgery. Despite their high effectiveness, there is a small risk of infections, which, in rare cases, can lead to serious complications, especially when the catheter is placed neuraxial. Even mild infections often necessitate the premature removal of the catheter, thereby compromising pain management. Immunocompromised patients are at an increased risk for various infections, including those associated with analgesia catheters. However, the extent of this risk and whether these patients benefit more from antibiotic prophylaxis had previously been unclear. In this large-scale registry study, we extracted data from the Network for Safety in Regional Anaesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We included over 196,000 catheters, and more than 1,300 placed in immunocompromised patients. Catheters placed in immunocompromised patients were more frequently infected and with greater severity, although infections were rare in both groups. Antibiotic prophylaxis was more effective in immunocompromised patients, significantly reducing the risk and severity of infections. Perioperative antibiotic prophylaxis even reduced the risk of catheter-related infections in immunocompromised patients to levels comparable to those in immunocompetent patients. Our findings emphasize the need for individualized infection prevention strategies. While routine antibiotic prophylaxis is not necessary for most patients, severely immunocompromised patients may benefit. The placement of analgesia catheters in immunocompromised patients already receiving antibiotic prophylaxis due to surgical indications can be considered safe in terms of infection risk. These insights support improved clinical decision-making and optimized perioperative care for this particularly vulnerable patient group.
Publications
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Infektionen von Regionalanästhesiekathetern und die Wirksamkeit einer Antibiotikaprophylaxe in immungeschwächten Patienten: eine retrospektive multizentrische Registeranalyse (Oral Presentation). German Anaesthesia Congress (DGAI), Kassel, Germany, September 2024
Müller-Wirtz L.M., Patterson W.M., Ott S., Ruetzler K., Turan A., Sessler D.I., Volk T. & Kubulus C.
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Regional analgesia catheter infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: a retrospective multicenter registry analysis. Annual Meeting of the American Society of Anesthesiologists, Philadelphia, USA, October 2024
Patterson W.M., Ott S., Ruetzler K., Turan A., Sessler D.I., Volk T., Kubulus C. & Müller-Wirtz L.M.
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Regional analgesia catheter infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: a retrospective multicenter registry analysis. Congress of the European Society of Anaesthesiology and Intensive Care (ESAIC), Munich, Germany, May 2024
Patterson W.M., Ott S., Ruetzler K., Turan A., Sessler D.I., Volk T., Kubulus C. & Müller-Wirtz L.M.
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Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis. Journal of Clinical Anesthesia, 103, 111826.
Müller-Wirtz, Lukas M.; Patterson, William M.; Ott, Sascha; Ruetzler, Kurt; Turan, Alparslan; Sessler, Daniel I.; Volk, Thomas; Kubulus, Christine; Steinfeldt, Thorsten; Fröhlich, Dieter; Spies, Claudia; Armbruster, Wolf; Przemeck, Michael; Gottschalk, André; Timmermann, Arnd; Wirtz, Stefan; Meier-Hellmann, Andreas; Burgard, Gerald; Fischer, Lars ... & Kranke, Peter
