Medical Device Associated Infections

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Chapter: Pharmaceutical Microbiology : Clinical Uses Of Antimicrobial Drugs

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.


MEDICAL DEVICE ASSOCIATED INFECTIONS

 

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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