Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-04-01 DOI:10.1016/j.jclinane.2025.111826

Lukas M. Müller-Wirtz MD , William M. Patterson MPH , Sascha Ott MD MPHA , Kurt Ruetzler MD , Alparslan Turan MD , Daniel I. Sessler MD , Thomas Volk MD , Christine Kubulus MD

{"title":"Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis","authors":"Lukas M. Müller-Wirtz MD , William M. Patterson MPH , Sascha Ott MD MPHA , Kurt Ruetzler MD , Alparslan Turan MD , Daniel I. Sessler MD , Thomas Volk MD , Christine Kubulus MD","doi":"10.1016/j.jclinane.2025.111826","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.</div></div><div><h3>Methods</h3><div>Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.</div></div><div><h3>Results</h3><div>We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], <em>p</em> = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], <em>p</em> < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], <em>p</em> = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], <em>p</em> = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.</div></div><div><h3>Conclusions</h3><div>Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111826"},"PeriodicalIF":5.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818025000868","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.

Methods

Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.

Results

We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 (97.4 %)), mild (4517 (2.3 %)), and moderate/severe (627 (0.3 %)). In immunocompromised patients, infection severities were none (1285 (95.4 %)), mild (58 (4.3 %)), and moderate/severe (4 (0.3 %)). Immunocompromised patients who were not given antibiotics had a 29 % greater infection hazard (HR 1.29 [95 %CI: 0.95, 1.76], p = 0.1) and 91 % greater odds of higher infection severities (OR 1.91 [95 %CI: 1.39, 2.63], p < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95 %CI: 0.38, 1.12], p = 0.12) and preventing infection (OR 0.54 [95 %CI: 0.31, 0.94], p = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed-to-treat to prevent an infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.

Conclusions

Regional analgesia catheter-related infections occur slightly earlier and are more frequent in immunocompromised patients. Antibiotics are marginally effective for catheter infection prophylaxis and should be restricted to patients who are severely immunocompromised with and at special risks.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.