Healthcare-Associated Infections _ ______________________________________________________________
DEVICE-RELATED INFECTIONS (Continued)
Type of Device
Prevalence
Probable Cause
Typical Duration to Occurrence after Implantation Within 30 to 90 days
Most Common Micro-organisms
Signs and Symptoms
Diagnosis
Treatment
S. aureus, Streptococcus pneumoniae, Haemophilus influenzae
Cochlear implants
1.7% to 3.3% Contamina- tion at time of implantation
Skin flap necrosis, wound dehiscence, wound infection
Not available
Antibiotic therapy, incision and drainage, local wound care; removal of device if extrusion of device or implant-related sepsis
S. aureus, Propioni- bacterium acnes , Micrococcus spp., E. coli , Klebsiella spp., Enterobacter spp., Serratia spp. (early); coagulase- negative staphylo- cocci (late)
Transvenous permanent pacemakers/ automatic implantable cardioverter defibrillators
1% to 7% Intraoperative contamination of the device or the
Within 30 days (early); within 60 days (late)
Erythema, pain, warmth at site (“pocket cellulitis”), draining sinus tract or erosion of overlying skin, systemic symptoms (fever, chills, malaise, nausea) Erythema, edema, poor healing, purulent discharge, inflammatory symptoms (breast or axillary pain, paresthesia of upper extremity) Persistent pain, fever, evidence of wound infection (early); loosening of prosthesis, sinus tract formation with discharge
Blood cultures, transesophageal echocardiog- raphy
Prolonged antibiotic
therapy, removal of all hardware; empiric therapy with vancomycin, gentamicin, or rifampin
pocket (early); contamination of pocket as a result of erosion of generator/
defibrillator through skin (late)
1.7% to 2.5% a
Not available
Within 2 to 4 weeks
S. aureus , pepto- streptococci, Clos- tridium perfringens
Wound or fluid culture
Empiric antibiotic
Breast implants
therapy, local debridement
Orthopedic implants
<1% to 2% Intraoperative contamination (early and late)
<2 to 4 weeks (early); >30 days (late)
S. aureus , coag- ulase-negative staphylococci, Propionibacterium spp. (early and late)
Joint aspiration, complete blood count, erythrocyte sedimentation rate, C-reactive protein, imaging
Surgical exploration and debridement followed
by empiric antibiotic therapy
a After augmentation mammoplasty; rates may be higher after mastectomy. Source: [123]
Table 5
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