How Long Does it Take for Infection after ESI

[Dr Manhattan]

I have had a hard time finding literature regarding typical time of onset of infection (discitis, meningitis, epidural abscess) as a complication after ESI.

What is everyone's knowledge and opinion regarding time of onset?

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[Dr Manhattan]

1. http://www.sld.cu/galerias/pdf/sitios/anestesiologia/discitis_post_esteroide_peridural_lumbar.pdf
7 days average. 75% interquartile reported at 21 days

2.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642757/
This comprehensive review has average onset of infection at under 20 days, with longest onset at day 56

Thoughts?

 

[willabeast]

i am thinking 3 days to 6 weeks.

 

[Aether2000]

One of the most difficult issues regarding infections are the variable timeframes of onset due to symptom manifestations that vary temporally. I have seen meningitis develop 10 days after an epidural steroid injection with back pain as the only early symptom- the same symptom they had prior to the injection, and there was no fever or neurological change before that time....

 

[knoxdoc]

Hooten's paper (Pain Med, 2006) indicated a median time of onset of symptoms to be 7 days after procedure. Other sources suggest 1-4 weeks. I don't start getting concerned until one week, because as you know many patients have expected post-procedural pain. If they are still having problems at one week, I will examine them and get a CBC, ESR, CRP. If there are lab abnormalities, get an MRI with contrast. You can go with the MRI before labs (i.e. neuro deficits, etc), just use your judgment. As Algos pointed out, the presentation can be very non-specfic. Pain out of proportion to objective findings is common.

 

[clubdeac]

What about hematoma... probably most likely within the first 24 hours but how long after an injection can one develop? Anyone have literature on this?

 

[SpineShot]

I generally think of 6-36 hrs as window for hematoma, 3-21 days for infection. Obviously overlap can occur and NEW or changing neuro deficit is always concerning. Hematoma could form quickly depending on vessels injured.