Foreign body infections due to Staphylococcus epidermidis.
Staphylococcal infections are one of the main causes of complications in patients with implanted foreign prosthetic material. Implants are associated with a significant reduction of the threshold at which contaminating Gram-positive bacteria, particularly Staphylococcus epidermidis, become infectious and develop a biofilm with phenotypic resistance to almost all antibiotics. A 1000-fold increase in minimal bactericidal levels against most antibiotics except rifampin has been repeatedly observed. Since only removal of the foreign material reverses these phenomena, the clinical challenge consists in finding approaches to cure the infection without removal of the implanted device. Rifampin combinations with other antibiotics, administration of exceedingly high antibiotic concentrations in situ, and early therapy before biofilm development are efficacious. Although these strategies have dramatically improved the outcome of foreign body infections, an improved understanding of biofilm-grown S. epidermidis is necessary to develop new antibacterial agents. Here, we review the pathogenesis, prevention, and treatment of implant infections due to S. epidermidis and highlight some new compounds with already promising in vitro results.
Uçkay
Ilker
I
University of Geneva Hospitals and Faculty of Medicine, Switzerland.
Pittet
Didier
D
Vaudaux
Pierre
P
Sax
Hugo
H
Lew
Daniel
D
Waldvogel
Francis
F
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D018441:Biofilms / Q000254:growth & development; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005547:Foreign Bodies / Q000382:microbiology; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000382:microbiology* / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000517:prevention & control; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000502:physiology
D000900:Anti-Bacterial Agents