_______________________________________________________________ Healthcare-Associated Infections
DEVICE-RELATED INFECTIONS
Type of Device
Prevalence
Probable Cause Typical
Most Common Micro-organisms
Signs and Symptoms
Diagnosis
Treatment
Duration to Occurrence after Implantation
Left ventricular assist devices
25% to 50% Biofilm formation
Within 2 to 6 weeks
Methicillin- resistant staphy- lococcal spp., Pseudomonas spp., Klebsiella spp., E. coli , Enterobacter spp., Proteus spp., Serratia spp., Candida spp., Enterococcus spp. Staphylococcus epidermidis (40% to 45%), S. aureus (25%), Klebsiella spp., Enterobacter spp., Pseudomonas aeru- ginosa , Acineto- bacter baumanii , Corynebacterium spp., Propioni bacterium spp., and streptococci/ enterococci
Signs of poor healing, localized inflammation, pocket abscess, frank sepsis, new and persistent drainage
Blood cultures
Empiric therapy with vancomycin and an anti- pseudomonal agent (ceftazidime or ciprofloxacin)
or empiric antifungal therapy
Cerebrospinal fluid (CSF) shunts
10%
Bacteria originating from patient’s skin introduced at time of operation
Within 30 days
Fever, focal pain, ventriculitis with lethargy and malaise (proximal shunts), infected intraperitoneal fluid cysts, or frank peritonitis (distal shunts)
CSF analysis (cell count, glucose, protein), gram stain, culture; abdominal ultra-sonography (distal shunts)
Antimicrobial agent effective against noted micro-organisms, modified with results of culture; removal of shunt
Prosthetic cardiac valves
3% to 5.7% Contamination of the valve at
Within 60 days (early)
Coagulase- negative staphylococci, specifically methicillin- resistant S. epidermidis , S. aureus
Fever, new or changing regurgitant murmurs, CHF, shock, cardiac conduction disturbances on EKG
Blood cultures, transesophageal echocardiog- raphy
Delayed antibi- otic therapy until results of culture available (if subacute course and hemody- namically stable); empiric antibi- otic therapy with vancomycin, gentamicin, rifampin (evidence of significant valve
time of implanta- tion or transient bacteremia
dysfunction); valve replace- ment (new or increasing
murmurs, severe CHF, persistent fever)
S. epidermidis
Penile implants
2% to 8% Contamination at time of implantation
Not available
Erythema, induration, tenderness,
Culture of specimen from the operative site
Empiric antibiotic therapy with
fever, discharge, device extrusion, prosthesis- associated pain
ciprofloxacin or a cephalosporin for 10 to 12 weeks; removal
of implant if pain persists or recurs after antibiotic treatment or if purulent discharge Table 5 continues on next page.
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