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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Nov 06

DOI: 10.23736/S0375-9393.17.11920-6

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis

Andres ZORRILLA-VACA 1, 2 , Ryan J. HEALY 1, Lucia RIVERA-LARA 1, Michael C. GRANT 1, Lisa L. MARAGAKIS 3, Kevin ESCANDÓN-VARGAS 2, Marek A. MIRSKI 1

1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2 Faculty of Health, Universidad del Valle School of Medicine, Cali, Colombia; 3 Department of Hospital Epidemiology and Infection Control, Johns Hopkins University School of Medicine, Baltimore, MD, USA


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BACKGROUND: Neuraxial anesthesia in the form of spinal and epidural are two of the most frequent forms of regional anesthesia. We aimed to describe and compare the relevant epidemiological, clinical and microbiological characteristics of all reported cases of septic meningitis associated with the use of spinal and epidural anesthetics.
METHODS: We performed a systematic review of septic meningitis associated with neuraxial anesthesia. We included all relevant case-reports and observational studies in which authors described septic meningitis in association with spinal, epidural or combined neuraxial anesthesia using local anesthetics.
RESULTS: A total of 234 cases of septic meningitis were reported following review of 71 casereport articles and 22 epidemiological studies. In total, there have been 199, 25 and 10 reported cases of septic meningitis associated to spinal, epidural and combined neuraxial anesthesia, respectively. The lack of use of surgical masks was the most common risk factor (41, 16.7%). Streptococcus salivarius was the most common bacteria (17.0%) related to spinal anesthesia and Staphylococcus aureus (26.7%) was the most common one related to epidural. The time to symptom onset was significantly reduced in spinal (median time, 24 hours IQR [8-72] vs. 96 hours IQR [84-240]; P = 0.003) compared to epidural anesthesia. The overall mortality rate is 15.3% and 13.3% for reported cases related to spinal and epidural anesthesia, respectively.
CONCLUSIONS: While the true incidence remains speculative, this review suggests that given increasing indications for spinals and epidurals, septic meningitis remains an important associated with neuraxial anesthesia.


KEY WORDS: Anesthesia, spinal - Anesthesia, epidural - Regional Anesthesia - Anesthesiology - Meningitis - Infection - Patient safety

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Publication History

Article first published online: November 06, 2017
Manuscript accepted: October 30, 2017
Manuscript revised: July 17, 2017
Manuscript received: January 9, 2017

Per citare questo articolo

Zorrilla-Vaca A, Healy RJ, Rivera-Lara L, Grant MC, Maragakis LL, Escandón-Vargas K, et al. Epidemiology of septic meningitis associated with neuraxial anesthesia: a historical review and meta-analysis. Minerva Anestesiol 2017 Nov 06. DOI: 10.23736/S0375-9393.17.11920-6

Corresponding author e-mail

andres.zorrilla@correounivalle.edu.co