Microbial infections vancomycin

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. 

Published guidelines on the management of catheter-related infections are in favor of the use of ALT for the treatment of catheter-related infections [24]. The in vitro stability of antibiotic-heparin combinations in CVCs was studied by Vercaigne et al. [25]. While ciprofloxacin produced immediate precipitation with heparin, cefazolin, vancomycin and ceftazidime at 10 mg/ml and gentamycin at 5 mg/ml were successfully incubated with heparin (5,000 U/ml) for 72 h in the central venous catheter lumen. Although free antibiotic in CVC solution was reduced, the final concentration was still sufficient for an effective antibiotic-heparin lock [25]. Good evidence is available to support ALT in the prevention of catheter-related bacteremia in patients on hemodialysis [26,27]. However, others have reported that the use of ALT may be limited due to antibiotic toxicity and the appearance of antibiotic-resistant microbial isolates [28, 29]. 

The emergence of microbial pathogens that are resistant to multiple classes of available antimicrobial agents is becoming a major worldwide pubhc health concern. These multidrug resistant bacteria are ubiquitous in both hospital and community settings [ 120]. The majority of these strains have been found to carry multiple drug resistance factors. At present, the only effective treatment for multiply resistant bacterial infections is vancomycin. Unfortunately,... 

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