![]() ![]() ![]() Catheter insertion and maintenance can be successfully introduced using a “bundle” approach. Central venous catheters should be inserted using full sterile barrier precautions following disinfection of the skin with chlorhexidine. Prevention of infection due to CoNS becomes more relevant in the setting of surgical implantation of prosthetic medical devices and insertion and care of intravascular catheters. Standard infection control measures (hand hygiene, routine environmental cleaning and disinfection) are adequate. Longer-term population analysis is better addressed by multi-locus sequence typing (MLST).ĬoNS are ubiquitously present on human skin and lack the intrinsic virulence of S. Finding indistinguishable PFGE patterns in the context of an outbreak or in complex clinical situations is a reliable indicator of clonality. There is great diversity in pulse-field patterns. Pulse field gel electrophoresis (PFGE) is generally regarded as the best test to address questions of short-term molecular epidemiology. As the use of such devices has increased in developed countries, the incidence of infection due to CoNS has increased in tandem. Similarly, CoNS are a leading cause of various other device-associated infections, including vascular grafts, cerebro-spinal fluid (CSF) shunts, prosthetic joints, and artificial heart valves. epidermidis, are the leading cause of nosocomial bloodstream infections and are responsible for approximately 30% of these infections, which are chiefly due to intravascular catheters. ![]() Their pathogenic potential resides in their ability to colonize biomaterials and cause medical device infections. How do patients contract this infection, and how do I prevent spread to other patients?ĬoNS are commensal flora of the human skin and mucous membranes and rarely cause primary disease. Biofilm-associated CoNS are generally much less susceptible to antibiotics than planktonic cells, and, oftentimes, effective therapy of biomaterial-based infections requires removal of the device. Many clinicians add rifampin (600 mg/day) to regimens containing vancomycin when treating a biomaterial-based infection (prosthetic joint infection, prosthetic valve endocarditis, etc.).Ī characteristic of CoNS infections involving medical devices (intravascular catheters, vascular grafts, prosthetic joints, CSF shunts, etc.) is the presence of biofilm and “persister” cells. The benefit of higher-dose vancomycin (trough levels of 15-20 ug/mL) is not well-defined for CoNS infections and may lead to increased risk of nephrotoxicity. Dosing of vancomycin is based on actual weight and renal function. epidermidis and other CoNS, because 80-90% of strains responsible for nosocomial infections are resistant to semi-synthetic, penicillinase-stable penicillins, such as oxacillin and nafcillin. Vancomycin is generally the cornerstone for treatment of infections due to S. ![]()
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