Preventive measures against transcutaneous device infections

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.