Antimicrobial Modifications on Critical Care Implants

Abstract

Healthcare-associated infections (HAIs) are a leading cause of mortality and morbidity globally. Intensive care unit (ICU)-acquired infections represent the majority of HAIs and are most often associated with the use of invasive medical devices. These infections highly correlate with bacterial colonization and biofilm formation on the devices and can be complicated by other device-associated complications. In this chapter, advances in antimicrobial modifications on implantable medical devices, especially on typical critical care implants, are reviewed. The first part of the chapter introduces biofilm formation and its clinical linkage to HAIs. The second part reviews three infections classified by devices, i.e., catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), summarizing their causes, etiologic agents, and infection–complication relationship. The third part of the chapter investigates three typical critical care implants, i.e., vascular catheters, endotracheal tubes, and urinary catheters, focusing on substrate polymers and functional coatings to reduce device-associated complications especially those have been clinically evaluated. The last part overviews technologies have yet been clinically approved on medical implants but shown promising results to reduce bacterial colonization or biofilm formation.