Methicillin-resistant Staphylococcus aureus (MRSA) Skin Infection after Epidural Anaesthesia.
-A case report-

Caldeira A., Albuquerque D., Henriques D., Monteiro M..

Hospital Santa Maria – Centro Hospitalar Lisboa Norte


Background
Regional anaesthetic (RA) techniques provide excellent anaesthesia and analgesia for surgical procedures, with many benefits compared to general anaesthesia. Most complications of RA are minor, but sometimes serious damage can occur like direct nerve damage, infection and spinal cord compromise.
Infectious complications may result in devastating morbidity, including abscess formation, necrotizing fasciitis, meningitis, paralysis and death. 

Case Report
We reported a case of MRSA skin infection after epidural anaesthesia in a 66-year-old man who was submitted to total knee arthroplasty under sequential combined-spinal epidural anaesthesia.
The operative procedure, anaesthesia and early postoperative course were uneventful.
After 5 days the catheter was removed and the patient was discharged from the orthopedic service. 
He returned after 5 days for orthopedic follow-up consultation. The Acute Pain Service of the Anaesthesiology Department was called for an erythematous and purulent lesion on the catheter exit site, which was aspirated for bacterial culture, so that susceptibility testing could be performed.
The culture was positive for MRSA and the patient was admitted to begin treatment with Linezolid 600 mg twice a day, after consulting the Infection Control Commission.
During hospitalization he presented clinical and laboratory improvement and was discharged after 8 days, with Linezolid prescription for 6 weeks, with no further complications.

Discussion
Catheters should not remain longer than clinically necessary and in our case maybe it was too long because the pain was already controlled. 
Bacterial filters may be considered during extended continuous epidural infusion, as in our case.
Aseptic technique and sterile occlusive dressings should always be used during the placement of neuroaxial catheters, combined with skin preparation using clorhexidine.
Disconnection/reconnection of systems should be limited to minimize the risk of complications.

Methicillin-resistant Staphylococcus aureus (MRSA) skin infection after epidural anaesthesia: a case report