Foreign body infections due to Staphylococcus epidermidis

Ann Med. 2009;41(2):109-19. doi: 10.1080/07853890802337045.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Antibiotic Prophylaxis
  • Biofilms / growth & development
  • Catheterization, Central Venous / adverse effects
  • Catheters, Indwelling / microbiology*
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Foreign Bodies / microbiology
  • Humans
  • Joint Prosthesis / adverse effects*
  • Joint Prosthesis / microbiology
  • Prosthesis Failure
  • Prosthesis-Related Infections / drug therapy
  • Prosthesis-Related Infections / microbiology*
  • Prosthesis-Related Infections / prevention & control
  • Staphylococcal Infections / drug therapy*
  • Staphylococcal Infections / prevention & control
  • Staphylococcus epidermidis* / drug effects
  • Staphylococcus epidermidis* / physiology

Substances

  • Anti-Bacterial Agents