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Correspondence  |   June 2017
Measurement of Patient Outcomes Important
Author Notes
  • UCL/UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, United Kingdom. d.mcguckin@ucl.ac.uk
  • (Accepted for publication March 13, 2017.)
    (Accepted for publication March 13, 2017.)×
Article Information
Correspondence
Correspondence   |   June 2017
Measurement of Patient Outcomes Important
Anesthesiology 6 2017, Vol.126, 1202. doi:10.1097/ALN.0000000000001637
Anesthesiology 6 2017, Vol.126, 1202. doi:10.1097/ALN.0000000000001637
To the Editor:
It was welcoming to read that Bomberg et al.1  found a low incidence of catheter-related infections in their study published in the September 2016 issue of Anesthesiology. I was intrigued to read that single-dose antibiotic prophylaxis for surgical-site infection was associated with a significant reduction in catheter-related infections, but this gives rise to more questions.
Other studies2,3  have found a low morbidity resulting from catheter-related infections, so is the risk reduction found in this study clinically relevant? Does it justify the potential implications of cost and antimicrobial resistance? The authors state that they have insufficient information on the severity of the infections (whether they required antibiotic therapy or surgical intervention), cost implications, and length of hospital stay, as well as any impact on longer term outcome (functional well-being, morbidity, and mortality). I wonder if the authors have considered data linkage to national death registries or reviewing the clinical notes of a subset of their study population to answer some of these questions? These outcomes should be considered by clinicians and researchers designing databases and conducting future studies in this area.
There is increasing use of perineural catheters for continuous or intermittent nerve blockade outside of the perioperative period, where administration of antibiotic prophylaxis is not routine. Without a clear improvement in patient outcomes, it is difficult for me to justify a change in my practice. Further large prospective studies in this area are required.
Competing Interests
The author declares no competing interests.
Dermot G. McGuckin, M.B.B.Ch., B.A.O., UCL/UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Perioperative Medicine, University College Hospital, London, United Kingdom. d.mcguckin@ucl.ac.uk
References
Bomberg, H, Krotten, D, Kubulus, C, Wagenpfeil, S, Kessler, P, Steinfeldt, T, Standl, T, Gottschalk, A, Stork, J, Meissner, W, Birnbaum, J, Koch, T, Sessler, DI, Volk, T, Raddatz, A . Single-dose antibiotic prophylaxis in regional anesthesia: A retrospective registry analysis. Anesthesiology 2016; 125:505–15 [Article] [PubMed]
Nicolotti, D, Iotti, E, Fanelli, G, Compagnone, C . Perineural catheter infection: A systematic review of the literature. J Clin Anesth 2016; 35:123–8 [Article] [PubMed]
Cook, TM, Counsell, D, Wildsmith, JA ; Royal College of Anaesthetists Third National Audit Project: Major complications of central neuraxial block: Report on the Third National Audit Project of the Royal College of Anaesthetists. Br J Anaesth 2009; 102:179–90 [Article] [PubMed]