Bacterial meningitis secondary to spinal analgesia and anaesthesia

Abstract Introduction Although rare, infectious complications from spinal analgesia and anaesthesia (SA) can have serious morbidity and mortality. This study describes the clinical features and outcome of SA-associated bacterial meningitis in adults seen in a hospital over a 25 yearperiod. Methods We reviewed the charts of all patients (aged ≥14 years) diagnosed with SA-associated bacterial meningitis between 1982 and 2006. Results Eight cases of SA-associated bacterial meningitis were diagnosed (3.3% bacterial meningitis), with a median age of 62 years (range, 35–80). SA procedures were: morphine infusion pumps with epidural (3 cases) or intrathecal (3) catheters, spinal cord stimulation with epidural neuroelectrode (1), and epidural anesthesia (1). Site of spinal insertion was: cervical (2 cases), thoracic (3), and lumbar (3). The median time to onset of meningitis was 26 days (range, 7–101) after AE. The most common clinical findings were fever (8 cases, 100%), headache (7 cases, 87.5%), and neck stiffness (4 cases, 50%). CSF abnormalities were pleocytosis (8 cases, 100%), elevated protein level (8 cases, 100%), and hypoglycorrhachia (5 cases, 62.5%). The causative organisms were Staphylococcus epidermidis (2 cases), Staphylococcus aureus (2), Enterococcus faecalis (1), Streptococcus milleri (1), and S. epidermidis and Pseudomonas fluorescens (1); one patient had a negative CSF culture. Treatment included antibiotics and to remove the analgesia device in all patients. There was one death (12.5%). Conclusions SA is a rare predisposing condition to bacterial meningitis but, due to the seriousness of the infection, it should be considered in the differential diagnosis for any patient who develops fever or headache in this setting.