Infection Management

Infection Identification

The American Society of Anesthesiologists recommends daily assessment of patients for early signs and symptoms of infection, such as fever, back pain, headache, redness and swelling at the insertion site 1, 3
For elderly patients in long-term care facilities, monitoring for signs of infection, including functional decline, such as new or increased confusion, incontinence, falls, decreased mobility, decreased appetite, or non-cooperation with staff, is crucial 3, 4
Fever is defined as a single oral temperature ≥37.8°C, or repeated oral temperatures ≥37.2°C, or a body temperature increase ≥1.1°C above baseline 4

When infection is suspected, immediate measures include removing any existing catheters and considering culturing the catheter tip 1, 2
Appropriate blood tests, such as white blood cell count, sedimentation rate, and C-reactive protein, should be conducted 1, 3
Obtaining appropriate culture samples is necessary 1
If abscess or neurological dysfunction is suspected, imaging studies, such as MRI or CT scans, should be performed 1, 2

A complete blood count, including peripheral white blood cell and differential cell count, is essential, with manual differential count preferred to evaluate band forms and other immature forms 5
An elevated white blood cell count (>14,000 cells/mm³) or left shift (band forms or metamyelocytes ≥6%; or total band count ≥1,500 cells/mm³) requires careful evaluation for bacterial infection 5, 6

The American Society of Anesthesiologists recommends immediate administration of appropriate antibiotic therapy when early signs or symptoms of infection appear 1, 2
For severely infected patients, empirical antibiotic therapy should be started immediately and adjusted after culture results are obtained 7

If a patient has received neuraxial techniques, such as epidural anesthesia, and infection is suspected, the catheter should be removed immediately and the catheter tip cultured 1, 2
For patients with known or suspected bacteremia, consideration should be given to administering antibiotic therapy before performing neuraxial techniques 2
If a patient has a short-term peripheral intravenous catheter and infection is suspected, the catheter should be removed, and the catheter tip cultured semi-quantitatively, with at least two separate blood cultures obtained before starting antibiotic therapy 8