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Biomaterials Associated Infection pp 229–248Cite as

Preventive Measures Against Transcutaneous Device Infections

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Abstract

Transcutaneous medical devices are indispensible in medicine. Infection is the most frequently reported complication of indwelling devices and is associated with substantial costs, morbidity, and even mortality. Since antibiotics have limited efficacy in the treatment of such infections, removal of the device is required to eradicate the infection in a considerable number of cases. Therefore, measures to prevent contamination of devices during and after insertion are of crucial importance to minimize the incidence of device-related infection. Since the patient’s own skin microflora is considered a major source of infection of transcutaneous devices, reduction of skin colonization at the insertion site of devices has high priority as a means to reduce the incidence of infection. Strategies to reduce the risk for contamination of transcutaneous devices with skin bacteria include (1) hygiene measures during surgery, (2) promoting integration of implanted devices with host tissues, (3) surface modification of the device to prevent adherence of bacteria, and (4) topical antimicrobial prophylaxis. Use of antibiotics for topical antimicrobial prophylaxis is strongly discouraged in view of the risk for resistance development. Antiseptics can be effective to reduce the incidence of infection of transcutaneous devices, but application of these compounds is mainly restricted to superficial skin disinfection. In addition, there are increasing concerns regarding antiseptic ­resistance development related to the widespread use of these agents. Therefore, alternative antimicrobial strategies are urgently needed. The potential of antimicrobial peptides and of honey as novel antimicrobial agents to prevent infection of transcutaneous devices is discussed.

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Authors and Affiliations

  1. Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Meibergdreef 15, Amsterdam, 1105, The Netherlands

    Paul H. S. Kwakman & Sebastian A. J. Zaat

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  1. Paul H. S. Kwakman
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  2. Sebastian A. J. Zaat
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Correspondence to Paul H. S. Kwakman .

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Editors and Affiliations

  1. AO Research Institute Davos, Clavadelerstrasse 8, Davos Platz, 7270, Switzerland

    T. Fintan Moriarty

  2. , Medical Microbiology, Academic Medical Center, Meibergdreef 15, Amsterdam, 1105 AZ, Netherlands

    Sebastian A.J. Zaat

  3. University Medical Center Groningen, A. Deusinglaan 1, Groningen, 9713 AV, Netherlands

    Henk J. Busscher

Glossary

Antimicrobial peptides (AMPs)

Evolutionarily conserved component of the innate immune system found among all classes of life. The combined presence of cationic and hydrophobic domains AMPs results in specificity for interaction with negatively charged microbial membranes.

External fixator

Surgical treatment to set bone fractures in cases where a cast would not allow proper alignment of the fracture. Holes are drilled into uninjured areas of bones around the fracture and pins or wires are screwed into the holes. Outside the body, a scaffold-like frame is fixed to the pins or wires to make a rigid support.

Molecular typing

DNA-based methods to discriminate microbial isolates at a subspecies level to determine diversity and epidemiology of infections.

Ventricular assist device (VAD)

Implanted mechanical device to partially or completely replace the function of the left and/or right heart ventricle. Mostly used as a bridge to heart transplantation.

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Kwakman, P.H.S., Zaat, S.A.J. (2013). Preventive Measures Against Transcutaneous Device Infections. In: Moriarty, T., Zaat, S., Busscher, H. (eds) Biomaterials Associated Infection. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1031-7_10

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