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

Müller-Wirtz LM, Patterson WM, Ott S, Ruetzler K, Turan A, Sessler DI, Volk T, Kubulus C, Steinfeldt T, Fröhlich D, Spies C, Armbruster W, Przemeck M, Gottschalk A, Timmermann A, Wirtz S, Meier-Hellmann A, Burgard G, Fischer L, Adamzik M, Döffert J, Schmidt R, Böttcher F, Kessler P, Standl T, Hering W, Koch T, Volk T, Zöllner C, Bürkle H, Meißner W, Wulf HF, Winckelmann J, Meybohm P, Kranke P (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 103

Article Number: 111826

DOI: 10.1016/j.jclinane.2025.111826

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.

Involved external institutions

Universitätsklinikum des Saarlandes (UKS) Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Freiburg Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) Germany (DE) RKU - Universitäts- und Rehabilitationskliniken Ulm Germany (DE) Universitätsklinikum Würzburg Germany (DE) Berufsgenossenschaftliche Unfallklinik (BGU) Frankfurt am Main Germany (DE) Allgemeines Krankenhaus Celle Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Christliches Klinikum Unna gGmbH Germany (DE) Krankenhaus Diakovere Friederikenstift Hannover Germany (DE) DRK-Kliniken Berlin Germany (DE) HELIOS Kliniken Germany (DE) Klinikum Memmingen Germany (DE) Universitätsklinikum Knappschaftskrankenhaus Bochum Germany (DE) Kreisklinikum Calw-Nagold Germany (DE) Marienhospital Stuttgart Germany (DE) OP-Ambulanz Schmerzzentrum Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Städtisches Klinikum Solingen Germany (DE) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) St. Marien-Krankenhaus Germany (DE)

How to cite

APA:

Müller-Wirtz, L.M., Patterson, W.M., Ott, S., Ruetzler, K., Turan, A., Sessler, D.I.,... Kranke, P. (2025). Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis. Journal of Clinical Anesthesia, 103. https://doi.org/10.1016/j.jclinane.2025.111826

MLA:

Müller-Wirtz, Lukas M., et al. "Regional analgesia catheter-related infections and the effectiveness of antibiotic prophylaxis in immunocompromised patients: A retrospective multicenter registry analysis." Journal of Clinical Anesthesia 103 (2025).

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