A wide variety of medical devices are increasingly used in clinical practice. These range from vasculature and urinary catheters, prosthetic joints and heart valves, shunts and stents for improving the flow of CSF, blood or bile according to their site of use, to intracardiac patches and vascular pumps.
A wide variety of medical devices
are increasingly used in
clinical practice. These
range from vasculature and urinary catheters, prosthetic joints and heart valves, shunts and stents for improving the flow of CSF, blood
or bile according to their site of use, to intracardiac patches and vascular pumps. Unfortunately
infection is the most
frequent complication of their use and may result in the need to replace or
remove the device, sometimes
with potentially life-threatening and fatal consequences.
Infections are often
caused by organisms arising from the normal skin flora, which
gain access at the time of
insertion of the device. Staph. epidermidis is among the most
frequent of isolates. Following attachment to the
surface of the device,
the organisms undergo
multiplication with the formation of extracellular polysaccharide material (glycocalyx) which contains slowly
replicating cells to form
a biofilm. Microorganisms within a biofilm are less vulnerable to attack by host defences (phagocytes, complement and antibodies) and are relatively insusceptible to antibiotic therapy despite the variable ability
of drugs to
penetrate the biofilm.
Management approaches
have therefore emphasized the need for prevention through
the addition of good
sterile technique at
the time of insertion. Manufacturers
have also responded by
using materials and creating surface characteristics of implanted materials
inclement to microbial attachment. Likewise the use of prophylactic antibiotics at the time of insertion of deep-seated devices such as joint and heart valve prostheses has
further reduced the risk of infection. Once a medical
device becomes
infected, management is difficult. Treatment with agents such as flucloxacillin, vancomycin and most recently linezolid is often
unsuccessful and the only
course of action is to remove the device.
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