Incidence of bacterial meningitis following labor epidural

[k12balla]

Had a case within my group of a healthy 26 yo 60kg g1 term who received a lumbar epidural with sterile technique minus gown x1 attempt without complication. Pt has failure to progress, later taken back for routine c section with functional epidural. Pt discharged two days later with possible endometritis.

A week later pt has HA, neck stiffness, photophobia, LP shows high wbcs, mainly neutrophils, low to normal glucose and elevated protein. MRI shows meningeal enhancement. Pt started on empiric abx, although all cultures and stains negative to date.

As you can imagine, most attribute this to the epidural that was placed. A quick online query shows a few cases with spinal puncture and no masks used, but I've yet to hear of one transmitted through epidural route without, abscess formation, and with such a delayed presentation. Your thoughts would be appreciated.

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[Planktonmd]

This is probably bacterial meningitis secondary to the endometritis and the negative CSF cultures are a result of the antibiotic treatment the patient has received.
It's a partially treated bacterial meningitis that has nothing to do with the epidural.