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

Andres Zorrilla-Vaca, Ryan J. Healy, Lucia Rivera Lara, Michael C. Grant, Lisa Maragakis, Kevin Escandón-Vargas, Marek A Mirski

Research output: Contribution to journalReview article

Abstract

INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: A total of 234 cases of septic meningitis were reported following review of 71 case-report 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.

Original languageEnglish (US)
Pages (from-to)363-377
Number of pages15
JournalMinerva Anestesiologica
Volume84
Issue number3
DOIs
StatePublished - Mar 1 2018

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Meningitis
Meta-Analysis
Epidemiology
Anesthesia
Epidural Anesthesia
Spinal Anesthesia
Conduction Anesthesia
Masks
Local Anesthetics
Observational Studies
Anesthetics
Staphylococcus aureus
Epidemiologic Studies
Bacteria
Mortality
Incidence

Keywords

  • Anesthesia
  • Anesthesia
  • Anesthesia
  • Anesthesiology
  • Conduction
  • Epidural
  • Infection.
  • Meningitis
  • Spinal

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Epidemiology of septic meningitis associated with neuraxial anesthesia : A historical review and meta-analysis. / Zorrilla-Vaca, Andres; Healy, Ryan J.; Rivera Lara, Lucia; Grant, Michael C.; Maragakis, Lisa; Escandón-Vargas, Kevin; Mirski, Marek A.

In: Minerva Anestesiologica, Vol. 84, No. 3, 01.03.2018, p. 363-377.

Research output: Contribution to journalReview article

Zorrilla-Vaca, Andres ; Healy, Ryan J. ; Rivera Lara, Lucia ; Grant, Michael C. ; Maragakis, Lisa ; Escandón-Vargas, Kevin ; Mirski, Marek A. / Epidemiology of septic meningitis associated with neuraxial anesthesia : A historical review and meta-analysis. In: Minerva Anestesiologica. 2018 ; Vol. 84, No. 3. pp. 363-377.
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abstract = "INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: A total of 234 cases of septic meningitis were reported following review of 71 case-report 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.",
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T1 - Epidemiology of septic meningitis associated with neuraxial anesthesia

T2 - A historical review and meta-analysis

AU - Zorrilla-Vaca, Andres

AU - Healy, Ryan J.

AU - Rivera Lara, Lucia

AU - Grant, Michael C.

AU - Maragakis, Lisa

AU - Escandón-Vargas, Kevin

AU - Mirski, Marek A

PY - 2018/3/1

Y1 - 2018/3/1

N2 - INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: A total of 234 cases of septic meningitis were reported following review of 71 case-report 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.

AB - INTRODUCTION: 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. EVIDENCE ACQUISITION: 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. EVIDENCE SYNTHESIS: A total of 234 cases of septic meningitis were reported following review of 71 case-report 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.

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KW - Anesthesia

KW - Anesthesia

KW - Anesthesiology

KW - Conduction

KW - Epidural

KW - Infection.

KW - Meningitis

KW - Spinal

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