Biomaterials And Medical Device Associated Infections

Despite advances in materials and sterilisation, patients who receive biomaterials of medical device implants are still at risk of developing an infection around the implantation site. This book reviews the fundamentals of biomaterials and medical device related infections and methods and materials for the treatment and prevention of infection. The first part of the book provides readers with an introduction to the topic including analyses of biofilms, diagnosis and treatment of infection, pathology and topography. The second part of the book discusses a range of established and novel technologies and materials which have been designed to prevent infection. Provides analysis of biofilms and their relevance to implant associated infections. Assesses technologies for controlling biofilms. Considers advantages and disadvantages of in vivo infection studies.

Biofilms and Implantable Medical Devices: Infection and Control explores the increasing use of permanent and semi-permanent implants and indwelling medical devices. As an understanding of the growth and impact of biofilm formation on these medical devices and biomaterials is vital for protecting the health of the human host, this book provides readers with a comprehensive treatise on biofilms and their relationship with medical devices, also reporting on infections and associated strategies for prevention. Provides useful information on the fundamentals of biofilm problems in medical devices Discusses biofilm problems in a range of medical devices Focuses on strategies for prevention of biofilm formation

Biomaterials associated infection (BAI) is one of the most common complications associated with implantation of any biomaterial regardless of form or function. These infections usually involve bacterial colonization and biofilm formation on the biomaterial itself, rendering the infection impervious to antimicrobials and host defenses. In addition, it is becoming increasingly clear that infection of the surrounding tissues also plays an important role in BAI, and that the infection may be influenced by the composition and design of the implanted biomaterial. In this book, worldwide leaders in the field address this critical problem in the translation of biomaterials research into clinical practice. The book begins with an emphasis on the latest research in the pathogenesis of BAI from microbiological, immunological, and materials science perspectives. The current state of the art in antimicrobial activation of biomaterials through surface modification and the incorporation of antimicrobial agents is then discussed. In the concluding chapters, successful translation of a selection of antimicrobial technologies from preclinical research into clinical use is described alongside a discussion of the utility of these devices and perspectives for future development. This book is essential reading for researchers and clinicians who are interested in understanding the fundamentals of BAI, the latest in antimicrobial materials research, and the state of the art in clinically available antimicrobial containing medical devices.

The use of medical devices (e.g., catheters, implants, and probes) is a common and essential part of medical care for both diagnostic and therapeutic purposes. However, these devices quite frequently lead to the incidence of infections due to the colonization of their abiotic surfaces by biofilm-growing microorganisms, which are progressively resistant to antimicrobial therapies. Several methods based on anti-infective biomaterials that repel microbes have been developed to combat device-related infections. Among these strategies, surface coating with antibiotics (e.g., beta-lactams), natural compounds (e.g., polyphenols), or inorganic elements (e.g., silver and copper nanoparticles) has been widely recognized as exhibiting broad-spectrum bactericidal or bacteriostatic activity. So, in order to achieve a better therapeutic response, it is crucial to understand how these infections are different from others. This will allow us to find new biomaterials characterized by antifouling coatings with repellent properties or low adhesion towards microorganisms, or antimicrobial coatings that are capable of killing microbes approaching the surface, improving biomaterial functionalization strategies and supporting tissues’ bio-integration.

The initial design criteria in the choice of indwelling materials for medical and dental purposes may be pragmatic, and based on the necessary mechanical properties required to fashion a functional device. Orthopedic implants require strong materials for weight-bearing, and articulating surfaces such as joints require durability and resistance to wear. Stents and shunts require flexibility and patency, and sutures require a high tensile strength yet also must be flexible enough for intricate manipulation. As the devices became more sophisticated and developments in materials science provided more options for manufacture, implants are being used more frequently and with longer anticipated lifetimes. Concurrently, the design process increasingly incorporated biocompatibility and comfort into the design criteria. However, with longer lifetimes, the more frequent use of invasive surgical procedures involving indwelling devices and biologically-friendly materials, there has been a rise in the number of incidences of device-related infection. Urinary catheters have been estimated to account for 30% of all nosocomial infections [1]. Between 66 and 88% of these occur after urinary catheterization [2]. It is also reported that almost 100% of catheterized patients develop an infection in an openly draining indwelling catheter which has been in place for four days or more [2]. For some procedures, such as orthopedic joint arthroplasties, the diagnosed surgical site infection rates are relatively low (between 1% and 2%; [3]); however, the increasing number of patients undergoing joint-replacement surgery translates to large numbers of patients afflicted with the consequences of complicating infections per year. Furthermore, infection of artificial joints can be devastating, since oral or IV antibiotic therapy frequently fails to resolve the infection, with the only remaining course of action being surgical debridement or partial or total revision. These two examples, the first with very high numbers of patients but of lesser severity in terms of impact to the individual, and the second, low numbers but severe patient impact, reflect the incentive to pursue a third design criteria—that of infection resistance—into materials and devices [4]. In the following sections we will discuss the role of bacterial biofilms in infection, and the growing literature highlighting biofilms as an important cause of device-related infection.

This chapter focuses on adhesives used in direct physiological contact in dental and medical procedures. Activity in both areas has been quite extensive outside the United States for decades. In contrast, adhesive use in medical devices, patches, and plasters has been ongoing in the United States for a long time. In the case of medical devices, adhesion is concerned with the joining of materials such as plastics, elastomers, textiles, metals, and ceramics, which are examined in other chapters of the present volume and are covered in various references [1–6], The coverage of this chapter is devoted to applications where to adhesives are in direct contact with tissues and other live organs.

The use of medical devices (e.g., catheters, implants, and probes) is a common and essential part of medical care for both diagnostic and therapeutic purposes. However, these devices quite frequently lead to the incidence of infections due to the colonization of their abiotic surfaces by biofilm-growing microorganisms, which are progressively resistant to antimicrobial therapies. Several methods based on anti-infective biomaterials that repel microbes have been developed to combat device-related infections. Among these strategies, surface coating with antibiotics (e.g., beta-lactams), natural compounds (e.g., polyphenols), or inorganic elements (e.g., silver and copper nanoparticles) has been widely recognized as exhibiting broad-spectrum bactericidal or bacteriostatic activity. So, in order to achieve a better therapeutic response, it is crucial to understand how these infections are different from others. This will allow us to find new biomaterials characterized by antifouling coatings with repellent properties or low adhesion towards microorganisms, or antimicrobial coatings that are capable of killing microbes approaching the surface, improving biomaterial functionalization strategies and supporting tissues' bio-integration.

The aim of this book is to provide readers with a wide overview of the main healthcare-associated infections caused by bacteria and fungi able to grow as biofilm. The recently acquired knowledge on the pivotal role played by biofilm-growing microorganisms in healthcare-related infections has given a new dynamic to detection, prevention and treatment of these infections in patients admitted to both acute care hospitals and long-term care facilities. Clinicians, hygienists and microbiologists will be updated by leading scientists on the state-of-art of biofilm-based infections and on the most innovative strategies for prevention and treatment of these infections, often caused by emerging multidrug-resistant biofilm-growing microorganisms.