Infection of percutaneous devices: prevention, monitoring, and treatment

Infection continues to pose the major obstacle to long-term percutaneous access. Development of methods to prevent infection or techniques to determine early onset of infection at a time when antibiotic therapy may prove successful would be of enormous value. Our laboratory has been working toward developing and testing a noninvasive semiquantitative swab culture technique (SQ) to monitor percutaneous leads for infection. This technique was found to have a 76% sensitivity having identified 47 of 62 organisms detected by a quantitative tissue culture technique (Q) at the time of system explant. Furthermore, 47 of 61 organisms identified by the SQ technique accurately detected those isolated by the Q techniques. Accordingly, the SQ technique has a 77% specificity. This technique was capable of detecting organisms a median of 14 days prior to overt clinical infection. Prompt initiation of oral antibiotic treatment based on SQ results has doubled system survival compared with untreated systems. Clearly, the SQ technique has proven useful to monitoring percutaneous devices.