This article was medically reviewed by Dr. David Herman.
There’s a reason why use of medical devices are considered vital to the healthcare industry and patients alike. These innovative devices are not only designed to improve the quality of life of patients but can also save patients’ lives. However, the implantation of these devices come with their own set of risks, including the potential for implant-related infections.
In this blog, ID Care infectious disease specialist, Dr. David Herman, addresses the most important questions about medical device-related infections such as: How can medical devices or implants increase the risk of infection? What are the most common types of implant-related infections? What are the top ways to prevent them? And what are the available treatment options?
What is a Medical Device or Implant-Related Infection?
According to National Institutes of Health, each year half of almost 2 million healthcare-associated infections is due to medical devices or implants. The same way that bacteria can easily latch on many of our commonly used devices, bacteria can also contaminate the surface of a medical device that has been implanted in a patient’s body. This contamination can lead to an implant-related infection.
According to Dr. Herman, a medical device is any instrument, implant, or apparatus which is intended for use in the diagnosis or treatment of a disease. Examples of medical devices include pacemakers, prosthetic heart valves, prosthetic joints or joint implants, ports, stents, rods, catheters, among others.
Medical devices or implants are made from a variety of man-made materials including, but not limited to, metal, plastic, ceramic, and bone. Some medical devices are implanted surgically and are intended to be permanent while others are removable once they are no longer needed.
Dr. Herman notes that an infection occurs when a group of microorganisms, usually bacteria, stick onto the implant and then they cause a foreign body reaction, and the infection develops.
“A device infection is defined as a host immune response to one or more microbial pathogens like bacteria, viruses, or fungi, that’s on an indwelling implant. Bacteria are the most common, but occasionally a virus, or yeast, or even parasite, could cause these infections as well”, states Dr. Herman.
Are You at Higher Risk for Medical Device-Related Infections?
Dr. Herman states that there are risk factors for implant infections that “can decrease the body’s response to being able to fight infections and allow infections to set in by adhering to one of these devices.”
According to Medscape, the reason why certain groups of patients are at higher risk is due to their weakened immune systems. Also, these patients are not able to eliminate bacteria from their circulation as efficiently as healthy patients.
The following are considered high-risk patient groups and are more susceptible for acquiring a medical device-related infection:
Patients Who Have These Conditions are Considered High-Risk:
- Rheumatoid arthritis
- Chronic kidney disease
- On steroids or other biologic medicines
Types of Medical Device-Related Infections
There are several types of infections that can be developed from medical implants or devices. Dr. Herman explains that acquiring a bacterial “staph” infection, such as staphylococcus aureus or coagulase-negative staphylococci, is the most common after having a medical device implanted. He also notes that on occasion there may be mycobacteria within the family of tuberculosis or related diseases which can easily latch on to the devices as well.
There are also reports mentioned in Antimicrobe.org, demonstrating additional normal skin flora, such as Pseudomonas and Propionibacterium, colonizing on the device or the implant, resulting in an infection.
Fungal infections can also occur, especially the ones caused by candida. Viral and parasitic medical-implant related infections do exist, however, they are extremely uncommon and rare.
What is Biofilm Formation and Why is it Relevant to Implant-Related Infections?
Biofilm formation occurs when communities of microorganisms form a slime-like substance attaching themselves to surfaces. According to BioMed Central, this is how bacteria shield themselves from host immune cells and antibiotics leading to antibiotic resistance. Therefore, biofilm formation presents a major problem related to the success of certain common antibiotics and necessitates usage of stronger and more expensive antibiotics.
Multiple resources including the International Journal of Medical Microbiology, indicate that the bacteria found in a biofilm have a higher tendency to become resistant to antibiotics, making it a lot more challenging to treat when related to an implant-infecting bacteria.
Possible Warning Signs of Infection for Most Common Medical Implants
It is more likely for an infection to occur post-procedure once the device is already inside. According to Clinical Infectious Diseases, there are a variety of ways a medical device or an implant may get infected. It’s more common when an implant, even though previously sterilized and packaged, becomes colonized when it was opened and handled during the surgery.
Another way for it to be infected is when an infection starts on the surface of skin after the surgery, for example, when changing a surgical site dressing. This superficial infection, if untreated in a timely manner, can now penetrate deep into the implant. Finally, if a patient has a blood infection, these bacteria can travel through the bloodstream and settle on the surface of an implant or device, causing an infection.
It’s important to continuously monitor the surgical site for any signs of infection after getting a medical device implanted. Symptoms will vary depending on where the implant is located. Dr. Herman notes that patients who get prosthetic joints should look out for signs such as warmth, redness, pain, non-healing wound, drainage, and possibly a fever.
The most common devices or implants that can result in infections include:
- Urinary Catheter – a tube that collects urine from the bladder can sometimes get infected due to the length of time. It may also be only colonized and not infected.Possible symptoms: pain in the lower abdomen, bleeding, burning while urinating or increased frequency
- Central Line – central venous catheter is a tube that is inserted in a large vein. CDC reports that central line bloodstream infections can occur in people who get chemotherapy or other intravenous (IV) therapies like a port or PICC line.Possible symptoms: pain, redness, swelling, warmth, fever, or foul smell
- Prosthetic Joint – an orthopedic prosthesis that replaces a damaged joint. Patients who get hip, knee, shoulder, or ankle replacements are at risk for bacteria entering their bloodstream and adhering to the foreign body.Possible symptoms: pain, redness, warmth, fever, chills, swelling, or drainage
- Heart Pacemakers – a small under-the-skin device to control the heartbeat. Heart devices, pacemakers, wires, or defibrillators can become infected if exposed to bacteria.Possible symptoms: pain, redness, nausea, or drainage from a sore
Common Diagnostic Tools and Methods if a Medical Device-Related Infection is Suspected
If a patient suspects they may have an implant-related infection, they should consult an ID Care specialist who will do the following:
- Conduct a careful history and physical exam of the patient
- Test for presence of elevated serum inflammatory markers such as sedimentation rates and level of C-reactive protein (CRP) as these are elevated in almost all of medical device-related infections
- Arrange to have the joint aspirated and perform a joint fluid analysis, if it’s prosthetic joint device
- Perform urine cultures, specifically for suspected urinary catheter device infections, to see if anything grows
Diagnosing a medical device-related infection can be challenging at times. A patient may have pain with a prosthetic joint and not have fever, redness, or warmth. Our ID Care specialists work closely with surgeons to determine the root cause of the pain and if it is an infection.
How Does ID Care Treat a Medical Device-Related Infection?
Dr. Herman notes that it’s very unlikely to cure a device-related infection without removing the device. He also notes that treatments can be complicated depending on what kind of infection it is, or what kind of organism it is. “Sometimes if it’s an early infection like on a joint,” states Dr. Herman, “you can try and wash it out and then treat with antibiotics and it will get cured, but frequently it’s not going to get better unless it’s removed.”
Most of the medical-related infections are treated in the hospital because they will often require surgery and removal of the device. A long course of antibiotics may also be required depending on the infection.
Years ago, if patients needed six weeks of antibiotics, they would stay in the hospital for the entire duration. Now, with ID Care’s state-of-the-art infusion suites, we can treat our patients with antibiotics in an outpatient setting once they are stabilized and the infection in their bloodstream has been cleared. If they are eligible for home IV antibiotics, we then follow up in the office once a week.
When does an ID Care specialist get consulted? An ID Care specialist is consulted if there’s a concern of infection in the hospital. Together with the surgeons, we follow the patients throughout their treatment every step of the way.
We monitor patients closely and ensure they are not having any complications with their antibiotics. We also review their labs to determine their progress and maintain close communication with their surgeon. And if a patient visits one of our out-patient infusion suites for antibiotic treatment, we have expert specialists that can see them during their time of visit if needed.
Top Ways to Prevent an Implant Infection from the Start
Dr. Herman explains that patients need to be infection-free before the surgical procedure. It’s a multifaceted approach and the primary goal is to try to control extraneous factors before the device is implanted.
He notes that if a patient has a tooth abscess or a dental infection, it would need to be eradicated before the procedure. Diabetics need to have their blood sugar under control to prevent risk of wound infections. If patients have cancer or an autoimmune disease, their medications would need to be minimized as they are more prone to acquiring an infection at the time of surgery.
If patients have a history of frequently getting colonized with staph, the staphylococcal colonization will need to be completely gone beforehand. If a patient has skin boils before a joint replacement, that too would need to be eliminated before the procedure.
Dr. Herman states, “Frequently patients that get a medical implant will get a dose of antibiotics for prophylaxis at the time of the surgery to help decrease bacterial load, and hopefully decrease the risk of the device getting infected.”
What is ID Care’s Role with Infection Prevention and Control in Healthcare?
The physicians and advanced practice providers within ID Care play an integral role in helping prevent medical device-related infections. Many of our ID Care specialists are part of the infection prevention teams in hospitals and healthcare facilities we partner with.
Not only does our ID Care team coordinate the infection control committee and control the different protocols that are implemented, but we also work with the surgeons to talk about antibiotic prophylaxis or other preventative measures. We also work closely with infection control practitioners in the hospital as this is vital to the success of the protocols.
How Can ID Care’s Infectious Disease Experts Help You?
The expert infectious disease specialists at ID Care are here to address any concerns you may have about medical implant-related infections, or if you believe you may be infected. As the largest independent infectious disease practice on the East Coast, ID Care has 10 convenient locations throughout New Jersey as well as outpatient infusion suites to make your treatment as convenient as possible. To learn more, visit idcare.com or call 908-281-0221 to schedule a consultation with an ID Care expert.