Infection 21 Introduction

Another problem that plagues medical devices is infection, particularly catheters. Catheters are widely used in hospitals for a number of applications including liquid drainage/injection and instrument access. One of the leading problems with catheters is bacterial infection. Bacteria infect up to 54% of all catheters (Maki and Tambyah 2001; Trerotola 2000) and cause many serious complications including patient death. For example, catheter infection is associated with a mortality rate of 12-25% among critically ill patients (Sanders et al. 2008). Catheter-associated urinary tract infection (CAUTI) is the most common type (accounting for 40%) of hospital-acquired infections ("nosocomial infection"), resulting in serious complications such as bloodstream infection, and even death (Sanders et al. 2008). Each year, in the U.S. acute-care hospitals and extended-care facilities, CAUTI affects approximately one million patients, who then have increased institutional death rates (Trerotola 2000). Chronic indwelling urinary catheters also increase the risk of infection, accounting for 80% of all nosocomial urinary tract infections (Roe et al. 2008).

Infections have also been reported to be the most severe complication of tunneled dialysis catheters which are used by approximately 20% of hemodialysis patients in the U.S., resulting in serious systemic infections, including endocarditis, osteomyelitis, epidural abscess, septic arthritis, and even death (Maki and Tambyah 2001). Significantly, 14% of the deaths in people undergoing dialysis in 1996 were due to infection (Maki and Tambyah 2001).

Another example of serious catheter and catheter-related infections concerns the use of central venous catheters. Infection may occur in 3-7% of the approximately three million central venous catheters inserted annually in the U.S., resulting in 150,000-250,000 nosocomial bacteremias (bloodstream infection). The mortality rate for this type of infection is from 10 to 20% (Leitman and Valavanur 1999). Importantly, the average cost of care is $45,000 per patient with this type of infection (Pronovost et al. 2006).

Lastly, ventilator-associated pneumonia (VAP), an infection which can occur in the lung in patients undergoing mechanical ventilation through the use of endotra-cheal tubes, is the most common hospital-acquired infection in intensive care units. VAP occurs in approximately 9-18% of patients being intubated (Kollef et al. 2008). Bacteria colonize the endotracheal tubes and then quickly spread to the lungs due to breathing patterns of the patients. VAP usually occurs within 10 days after endotracheal intubation, resulting in an increased length of hospital stay and associated health-care costs (average cost is $40,000 per patient) and significant mortality (Kollef et al. 2008).

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Diabetes 2

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