Intravascular device-related infections

Switching from intravenous to oral antibiotics should be considered as soon as clinically appropriate. Prolonged intravenous therapy is associated with risk of intravascular device-related infection and delays discharge. Indicators for switch include resolution of fever, tachycardia, tachypnoea, hypotension and hypoxia and the patient should be clinically hydrated with good oral intake and no gastrointestinal absorption concerns. 

Pearson, M. L., Guideline for prevention of intravascular device-related infections. Part 1. Intravascular device-related infections An overview. Part II. Recommendations for the prevention of nosocomial intravascular device-related infections, Am. J. Infect. Control, 1996 24(4) 262-293. 

This chapter will be focused on antimicrobial PUs for intravascular applications. First, a classification of the types of PU intravascular devices and their impact in the medical held will be inhoduced. Then, a survey of infections associated with intravascular devices in terms of incidence, etiology, and pathogenesis will be presented. Next, management of device-related infections and the role of modified PUs in preventing intravascular device-related infections will be discussed. Finally, the future direction of novel antimicrobial polymers as biomaterials for the development of devices preventing biofilm-based infections will be described. 

Microrganisms involved in intravascular device-related infections... 

In the following sections, antifouling and antimicrobial PUs will be presented in relation to their application for preventing intravascular device-related infections. 

Dmg-releasing PUs can be considered the first milestone in the prevention of intravascular device-related infections. Already, their clinical application has contributed to decreasing infection risk, mortality rate, and patient morbidity. However, the use of these drag-releasing polymers has elicited concerns in terms of durability and possible local emergence of resistant microorganisms. 

An increasing proportion of inhavascular device-related infections are being caused by Candida spp. and the management of these infections can be challenging. Candida infections account for ca. 10% of the whole number of intravascular catheter-associated infections. Usually the management of these infections requires the device removal. 

A crucial feature required for a successful application of PUs as biomaterials is their ability to prevent microbial colonization. Indeed, any implanted biomaterial is known to have the potential to put the patient at high risk of infection. In case of intravascular devices, the development of device-related infections may result in life-threatening consequences for the patient. 

O Grady NP, Alexander M, Bums LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control May 2011 39(4 Suppl. l) Sl-34. Francolini 1, Donelli G. Prevention and control of biofilm-based medical-device-related infections. FEMS Immunol Med Microbiol August 2010 59(3) 227-38. 

Nosocomial bloodborne infections in hospitalized patients are associated with a two- to threefold increase in mortality. The origin of infection is usually either cannula-related or infusate-related. Cannula-related infections include those derived from percutaneous devices used for vascular access (e.g., needles, hubs, and plastic catheters). Maki reports that between 5 and 25% of intravascular devices are microbially colonized at the time of vascular withdrawal [25]. Large numbers of microorganisms are observed on the intravascular portion of the cannula or its tip (Fig. 1). 

Device-related, intravascular devices, ventilators, d tube feeding infections... 

Device-related, intravascular devices, ventilators, and tube-feeding infections Surgical-site infections and HAIs in special care units Infections caused by organisms that are antibiotic resistant Tuberculosis and other communicable diseases Infections in the neonate population Geographic location of the facility Volume of patient or resident encounters Patient populations served Clinical focus of the facility Number of employees and staff... 

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