Infections associated with intravascular devices

In developed countries endocarditis is present in 1/1000 hospital admissions or 1-2 cases per million population. An increasing number of endocarditis cases are associated with intravascular device infections and the placement of prosthetic valves thus, endocarditis can be acquired during hospital stay. Men are afflicted more often than females, and most patients are >50 years of age. Pre-existing heart lesions predispose to bacterial endocarditis if they are accompanied by (thrombotic) alterations of the endocardial surface or blood flow such that bacteria... 

DG Maki. Infections caused by intravascular devices used for infusion therapy pathogenesis, prevention and management. In AL Bisno, FA Waldvogel, eds. Infections Associated with Indwelling Medical Devices. Washington, DC ASM Press, 1994, pp. 155-212. 

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. 

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. 

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). 

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