Infections associated with indwelling devices: infections related to extravascular devices.

Infection complications of indwelling extravascular devices are reviewed including endotracheal tubes, urological catheters, cerebrospinal shunts, ocular prostheses, orthopedic protheses, peritoneal dialyses catheters, and IUDs. For each device a small number of pathogens accounts for the majority of infections. For most devices, infections of host skin origin, especially coagulase negative staphylococci are responsible. IUDs are exceptional because most are associated with bacteria which cannot be detected by usual culture methods. Acute endometritis may follow insertion, and pelvic inflammatory disease may develop rarely. For urinary catheters, gram negative bacilli from the bowel or antibiotic resistant hospital acquired organisms are common. Most foreign body infections require removal of the device before cure is possible. Exceptions are peritoneal dialysis catheters, intraocular lenses and some cases of prosthetic valve endocarditis by penicillin susceptible streptococci. Most infections originate during surgical implantation. Minimizing tissue trauma and operating time will reduce risk. Prophylactic antibiotics are appropriate for placement of artificial heart valves, joints and vascular grafts.