Systemic treatment options for medical device-associated infection

Abstract

Difficulties in eradicating medical device-related infections are primarily related to the presence of bacterial biofilms. The foreign body can often facilitate such infections, which may be usually caused by non-aggressive microorganisms with the ability to form biofilms even at low inoculum size. The biofilm is responsible for several phenotypic changes in the bacteria including increased minimal bactericidal concentrations (tolerance to antibiotics). Other factors that have also been related to difficulties in the treatment of medical device-related infections are functional abnormalities in the activity of phagocytic cells in contact with the foreign body and the presence of intracellular bacteria. While the anatomical location of the medical device can determine certain aspects of the treatment of these infections, this therapy must include an appropriate and lengthy antibiotic treatment combined with adequate surgical intervention. Antimicrobial therapy needs to be carefully designed, and the antibiotics to use against device-related infections can be chosen according both to their activity against bacterial biofilms and nongrowing microorganisms, and to their intracellular efficacy. The specific characteristics of medical device-related infections, as well as the difficulties involved in their treatment, mean that multidisciplinary medical teams are required to ensure the optimal approach to and management of this pathology.