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Nosocomial meningitis after spinal anaesthesia

Abstract number: p667

Kryeziu  R., Raka  L., Mulliqi-Osmani  G., Hyseni  H., Dedushaj  I., Kryeziu  D., Ramadani  N., Omeragiq  S., Muçaj  S.

Objectives: 

Nosocomial bacterial meningitis is a rare but serious complication of spinal anaesthesia. The aims of this study were to investigate an outbreak of nosocomial meningitis caused by Serratia marcescens in University Clinical Centre of Kosova among patients after spinal anaesthesia and to implement the appropriate control measures.

Methods: 

During September 8–11, 2003, three patients were referred from orthopaedic and abdominal surgery to the Infectious Disease department with clinical signs of meningitis after interventions proceeded by spinal anaesthesia. An epidemic investigation was therefore started to identify the source and to control the outbreak. A retrospective case control analysis of the clinical charts in the previous year, extensive microbiological sampling and review of the unit practices were performed. Aetiological diagnosis was based on culture of cerebrospinal fluid.

Results: 

Three cases during September 2003 had undergone spinal anaesthesia in the departments of orthopaedic and abdominal surgery. Patients developed meningeal syndrome 24–49 hours after spinal anaesthesia. The patients were from 16–50 years old. S. marcescens was isolated from cerebrospinal fluid culture of two patients. Cultures were obtained from potential environmental resources including anaesthesia equipment, medication solution, needles and syringes. Samples from vials containing fentanyle were positive for S. marcescens. In both orthopaedic and abdominal surgery departments, fentanyle containers were used as multi-dose vials covered by sticking-plaster. This practice was justified with limited resources. Antimicrobial susceptibility testing of isolates from patients and vials yielded the same pattern suggesting common source of infection. The outcome of disease was favourable in all patients. Retrospective review of patient's charts in previous year detected five cases of nosocomial meningitis from patients after spinal anaesthesia. In one case culture was positive for Serratia marcescens.

Conclusions: 

Our findings are consistent with break in aseptic techniques that could result in introduction of Serratia into the cerebrospinal fluid through multiple-use of anaesthetic solution. To prevent nosocomial iatrogenic infections caused by Serratia and other multiresistant bacteria, compliance with strict aseptic rules and comprehensive infection control procedures are recommended.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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