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Device-related Infections (device-related + infections)
ica and beyond: biofilm mechanisms and regulation in Staphylococcus epidermidis and Staphylococcus aureusFEMS MICROBIOLOGY LETTERS, Issue 2 2007
James P. O'Gara
Abstract Recent progress in elucidating the role of the icaADBC -encoded polysaccharide intercellular adhesin (PIA) or polymeric N -acetyl-glucosamine (PNAG) in staphylococcal biofilm development has in turn contributed significantly to our understanding of the pathogenesis of device-related infections. Nevertheless, our understanding of how the ica locus and PIA/PNAG biosynthesis are regulated is far from complete and many questions remain. Moreover, beyond ica, evidence is now emerging for the existence of ica -independent biofilm mechanisms in both Staphylococcus aureus and Staphylococcus epidermidis. Teichoic acids, which are a major carbohydrate component of the S. epidermidis biofilm matrix and the major cell wall autolysin, play an important role in the primary attachment phase of biofilm development, whereas the cell surface biofilm-associated protein and accumulation-associated protein are capable of mediating intercellular accumulation. These findings raise the exciting prospect that other surface proteins, which typically function as antigenic determinants or in binding to extracellular matrix proteins, may also act as biofilm adhesins. Given the impressive array of surface proteins expressed by S. aureus and S. epidermidis, future research into their potential role in biofilm development either independent of PIA/PNAG or in cooperation with PIA/PNAG will be of particular interest. [source]
Device-Related Infection Among Patients With Pacemakers and Implantable Defibrillators: Incidence, Risk Factors, and ConsequencesJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2010
PABLO B. NERY M.D.
Risk Factors and Complications of Pacemaker and ICD Infection.,Background: Device-related infection is a major limitation of device therapy for cardiac arrhythmia. Methods: The authors analyzed the incidence and risk factors for cardiac device infection (CDI) among consecutive patients implanted with pacemaker (PM) or implantable cardioverter defibrillator (ICD) (including cardiac resynchronization therapy devices) at a tertiary health center in Hamilton, Ontario, Canada. Most patients with device-related infections were identified by an internal infection control system that reports any positive wound and blood cultures following surgery, between 2005 and the present. A retrospective review of patient records was also performed for all patients who received an ICD or PM between July 1, 2003 and March 20, 2007. Results: A total of 24 infections were identified among 2,417 patients having device surgery (1%). Fifteen of these infections (60%) were diagnosed within 90 days of the last surgical procedure. Univariate analysis showed that patients presenting with CDI were more likely to have had a device replacement, rather than a new implant, had more complex devices (dual/triple chamber vs single), and were more likely to have had a prior lead dislodgement. Multivariate analysis found device replacement (P = 0.02) and cardiac resynchronization therapy (CRT)/dual-chamber devices (P = 0.048) to be independent predictors of infection. One patient developed septic pulmonary emboli after having laser-assisted lead extraction. No patient died and 22 patients received a new device. Conclusion: CDI occurs in about 1% of cases in high volume facilities. Pulse generator replacement surgery and dual- or triple-chamber device implantation were associated with a significantly increased risk of infection. (J Cardiovasc Electrophysiol, Vol. pp. 786-790, July 2010) [source]
Device Extraction in Adults with Congenital Heart DiseasePACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2009
DAVID CESARIO M.D., Ph.D.
Background: Device extraction is a critical component in the treatment of patients with device-related infections. Due to complex anatomic considerations, device extraction in adults with congenital heart disease presents unique challenges to the electrophysiologist. Methods: Here, we present a series of device-extraction cases performed in patients with transposition of the great arteries status post either Mustard or Senning surgical procedures that subsequently had permanent pacemakers placed and ultimately developed device-related infections. Results: All of these patients eventually underwent successful laser extractions of their infected devices resulting in complete removal of all hardware and resolution of their infections. Conclusions: These cases illustrate that endovascular device extraction has been safely and effectively performed in adult patients with congenital heart disease, though further studies are needed to determine the procedural risks and success rates of this procedure in this patient population. [source]
Introduction of Infection Control Measures to Reduce Infection Associated With Implantable Pain Therapy DevicesPAIN PRACTICE, Issue 3 2007
Abram H. Burgher MD
Abstract Introduction: Implantable pain therapy devices for chronic pain include spinal cord stimulators (SCS) and intrathecal drug delivery systems (IDDS). A number of different complications can occur after implantation of these devices, but among the most serious is infection. Based on Centers for Disease Control and Prevention guidelines for prevention of surgical site infection, published literature on infection risk with implantable pain therapy devices, and recommendations from groups within our own our institution, we introduced infection control measures for all patients receiving either SCS or IDDS. Methods: After approval from the Institutional Review Board, we performed a retrospective review of patients undergoing primary implantation of SCS or IDDS before and after introduction at our institution of safety measures designed to reduce device-related infection. We compared infection incidence and compliance to infection precautions before and after introduction of these measures. Results: Thirty-four SCS or IDDS were implanted before implementation of the infection control measures and 58 were placed after. Five device-related infections occurred. Adherence to most infection precautions improved during the study period, but 100% compliance was seen only with venue used for implantation. Infection incidence declined after introduction of the safety measures, but the reduction was not statistically significant. Conclusions: Introduction of infection control measures for implantable pain therapy devices improved adherence to most infection precautions in our practice. Lack of specific documentation could have hindered practice surveillance within our group. A tool to document performance of infection control measures would be useful not only as a marker of compliance but could also serve as a reminder to perform certain safety measures. [source]