November 29, 2025
Background: The risk of regional analgesia catheter-related infections in immunocompromised patients remains uncertain. We therefore tested the hypotheses that catheter-related infections appear earlier and are more severe, and that antibiotic prophylaxis is more effective in immunocompromised than immunocompetent patients.
Methods: Data were extracted from the Network for Safety in Regional Anesthesia and Acute Pain Therapy (net-ra) registry from 2007 to 2022. We used multivariable Cox and ordinal regression to assess the effect of immune function and antibiotic prophylaxis indicated by surgery on infection onset and severity.
Results: We analyzed data from 196,711 catheters, including 1347 in immunocompromised patients. Infection severities in immunocompetent patients were none (190,220 [97.4%]), mild (4517 [2.3%]), and moderate/severe (627 [0.3%]). In immunocompromised patients, infection severities were none (1285 [95.4%]), mild (58 [4.3%]), and moderate/severe (4 [0.3%]). Immunocompromised patients who were not given antibiotics had a 29% greater infection hazard (HR 1.29 [95% CI: 0.95, 1.76], p = 0.1) and 91% greater odds of higher infection severities (OR 1.91 [95% CI: 1.39, 2.63], p < 0.001). Antibiotics were more effective in delaying infection onset (HR 0.65 [95% CI: 0.38, 1.12], p = 0.12) and preventing infection (OR 0.54 [95% CI: 0.31, 0.94], p = 0.029) in immunocompromised than immunocompetent patients. The number of patients needed to treat to prevent one infection with antibiotics was 55 in immunocompromised patients versus 83 in immunocompetent patients.
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