Management of prosthetic device infections

Infection is a serious, often catastrophic, complication of implanted prosthetic devices. The presence of the device increases the risk of infection and, once established, infections are difficult to treat. At the site of these devices, infections are caused by normally avirulent bacteria. It appears that there may be an increased virulence of bacteria and an impairment of local host defence associated with prosthetic device infections. Treating these infections almost always requires surgical debridement, and often, removal of the prosthetic device. Removal versus retention of the device is the key decision that must be made in the management of these infections. Important factors to consider include the type and location of the device, whether the infection is early or late with respect to the implantation of the device, and the systemic effects of the infection. Currently the management of prosthetic device infections is based on surgical debridement and antibiotic therapy. A better understanding of the pathogenesis of these infections may lead to interventions that directly attenuate bacterial virulence or augment host response, which will result in better methods of treatment and improved outcomes.