PRACTICAL MEASURES TO CONTROL DEVICE-RELATED BACTERIAL-INFECTIONS

Direct examination of medical devices that have been foci of chronic d evice-related bacterial infections has shown that the causative organi sms grow predominantly in slime-enclosed biofilms. These adherent biof ilms are inherently resistant to host defences (antibodies, phagocytes ) and to conventional antibiotic therapy. Device-related infections ca n be prevented by careful cleaning and sterilization of the device, an d by the avoidance of any manipulations that would allow the formation of even the most rudimentary biofilm prior to implantation. Once a de vice-related infection has become established both the Minimum Inhibit ory Concentration (MIC) and the Biofilm Eliminating Concentration (BEC ) of the causative organism must be determined and therapeutic strateg y must aim at the use of the MIC to control the acute phase caused by planktonic bacteria and of the BEC to eliminate the biofilm nidus of i nfection. The removal of the colonized device should be considered ear ly in the course of treatment if the BEC cannot be delivered to the co lonized device. We describe a new bioelectric technology presently in the in vitro stage of development which, if it can be reproduced in vi vo, will be very effective in the prevention and control of device-rel ated bacterial infections.