Antimicrobial and Anti-Biofilm Medical Devices: Public Health and Regulatory Science Challenges

Wang, Yi; Jayan, Geetha; Patwardhan, Dinesh V.; Phillips, K. Scott

doi:10.1007/978-3-319-57494-3_2

Cited by 23 publications

(17 citation statements)

References 121 publications

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“…Once established at the biomaterial surface, bacteria can disseminate to other body sites and elicit severe secondary infections that contribute dramatically to patient morbidities and lifethreatening events 3,4 . Despite the efforts in the field, infections caused by biofilms continue to be one of the leading causes of nosocomial infections, with an economic impact comparable to that of major diseases such as breast and colorectal cancer 5 . On top of this, current estimates project their incidence will increase significantly by 2050 as a result of antibiotic resistance 2,5 .…”

Section: Introductionmentioning

confidence: 99%

“…Despite the efforts in the field, infections caused by biofilms continue to be one of the leading causes of nosocomial infections, with an economic impact comparable to that of major diseases such as breast and colorectal cancer 5 . On top of this, current estimates project their incidence will increase significantly by 2050 as a result of antibiotic resistance 2,5 .…”

Section: Introductionmentioning

confidence: 99%

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Bacterial envelope damage inflicted by bioinspired nanospikes grown in a hydrogel

Arias

Devorkin

Spear

et al. 2020

Preprint

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Device-associated infections are one of the deadliest complications accompanying the use of biomaterials, and despite recent advances in the development of anti-biofouling strategies, biomaterials that exhibit both functional tissue restoration and antimicrobial activity have been challenging to achieve. Here, we report the fabrication of bio-inspired bactericidal nanospikes in bacterial cellulose and investigate the mechanism underlying this phenomenon. We demonstrate these structures affects preferentially stiff membranes like those in Gram-positive bacteria, but exhibit cytocompatibility towards mammalian cells, a requisite for tissue restoration. We also reveal the bactericidal activity of the nanospikes is due to a pressure-induced mechanism, which depends on the cell's adherence time, nanospike's geometry and spacing, cell shape, and mechanical properties of the cell wall. Our findings provide a better understanding of the mechanobiology of bacterial cells at the interface with nanoscale structures, which is fundamental for the rational design bactericidal topographies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bacterial envelope damage inflicted by bioinspired nanospikes grown in a hydrogel

Arias

Devorkin

Spear

et al. 2020

Preprint

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“…In a study at a Pakistani paediatric intensive care unit, the incidence of device-associated infections reached a staggering 2.1 % [5]. Device-associated infections may lead to device removal and replacement, thus resulting in prolonged hospital stays, excessive medical costs, and higher morbidity and mortality [6,7]. It was estimated that in the United States alone a total of 82 000 deaths annually were caused by deviceassociated infections, with direct costs of $18 billion, an economic impact on a par with those of other major diseases such as breast cancer ($16.5 billion in 2010) [7].…”

Section: Introductionmentioning

confidence: 99%

“…Device-associated infections may lead to device removal and replacement, thus resulting in prolonged hospital stays, excessive medical costs, and higher morbidity and mortality [6,7]. It was estimated that in the United States alone a total of 82 000 deaths annually were caused by deviceassociated infections, with direct costs of $18 billion, an economic impact on a par with those of other major diseases such as breast cancer ($16.5 billion in 2010) [7]. The fact that many of the pathogens responsible for these infections are multi-drug-resistant, or even panresistant, has become particularly problematic, with few treatment options being available [8,9].…”

Section: Introductionmentioning

confidence: 99%

Surface micropattern reduces colonization and medical device-associated infections

Qiu-hua

Mettetal

et al. 2017

Journal of Medical Microbiology

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* AbstractPurpose. Surface microtopography offers a promising approach for infection control. The goal of this study was to provide evidence that micropatterned surfaces significantly reduce the potential risk of medical device-associated infections.Methodology. Micropatterned and smooth surfaces were challenged in vitro against the colonization and transference of two representative bacterial pathogens -Staphylococcus aureus and Pseudomonas aeruginosa. A percutaneous rat model was used to assess the effectiveness of the micropattern against device-associated S. aureus infections. After the percutaneous insertion of silicone rods into (healthy or immunocompromised) rats, their backs were inoculated with S. aureus. The bacterial burdens were determined in tissues under the rods and in the spleens.Results. The micropatterns reduced adherence by S. aureus (92.3 and 90.5 % reduction for flat and cylindrical surfaces, respectively), while P. aeruginosa colonization was limited by 99.9 % (flat) and 95.5 % (cylindrical). The micropatterned surfaces restricted transference by 95.1 % for S. aureus and 94.9 % for P. aeruginosa, compared to smooth surfaces. Rats with micropatterned devices had substantially fewer S. aureus in subcutaneous tissues (91 %) and spleens (88 %) compared to those with smooth ones. In a follow-up study, immunocompromised rats with micropatterned devices had significantly lower bacterial burdens on devices (99.5 and 99.9 % reduction on external and internal segments, respectively), as well as in subcutaneous tissues (97.8 %) and spleens (90.7 %) compared to those with smooth devices.Conclusion. Micropatterned surfaces exhibited significantly reduced colonization and transference in vitro, as well as lower bacterial burdens in animal models. These results indicate that introducing this micropattern onto surfaces has high potential to reduce medical device-associated infections.

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“…The fact that injection near infected skin regions is contraindicated because it increases complications also shows the importance of the skin as a source of contamination28. There is increasing comprehension that biofilm is the default lifestyle of bacteria2930, and recent studies suggest that many bacteria colonizing the skin produce biofilm31, which is resistant to dessication32. During injection, bacteria in biofilm can be introduced from the dermal matrix.…”

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confidence: 99%

Injections through skin colonized with Staphylococcus aureus biofilm introduce contamination despite standard antimicrobial preparation procedures

Wang

Leng

Patel

et al. 2017

Sci Rep

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While surgical site preparation has been extensively studied, there is little information about resistance of skin microbiota in the biofilm form to antimicrobial decontamination, and there are no quantitative models to study how biofilm might be transferred into sterile tissue/implant materials during injections for joint spine and tendon, aspiration biopsies and dermal fillers (DF). In this work, we develop two in vitro models to simulate the process of skin preparation and DF injection using pig skin and SimSkin (silicone) materials, respectively. Using the pig skin model, we tested three of the most common skin preparation wipes (alcohol, chlorhexidine and povidone iodine) and found that during wiping they reduced the biofilm bacterial burden of S. aureus (CFU cm−2) by three logs with no statistically significant differences between wipes. Using the SimSkin model, we found that transfer of viable bacteria increased with needle diameter for 30G, 25G and 18G needles. Transfer incidence decreased as injection depth was increased from 1 mm to 3 mm. Serial puncture and linear threading injection styles had similar transfer incidence, whereas fanning significantly increased transfer incidence. The results show that contamination of DF during injection is a risk that can be reduced by modifying skin prep and injection practices.

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Antimicrobial and Anti-Biofilm Medical Devices: Public Health and Regulatory Science Challenges

Cited by 23 publications

References 121 publications

Bacterial envelope damage inflicted by bioinspired nanospikes grown in a hydrogel

Bacterial envelope damage inflicted by bioinspired nanospikes grown in a hydrogel

Surface micropattern reduces colonization and medical device-associated infections

Injections through skin colonized with Staphylococcus aureus biofilm introduce contamination despite standard antimicrobial preparation procedures

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