Abstract
Over the past decades the use of medical devices, such as catheters, artificial heart valves, prosthetic joints, and other implants, has grown significantly. Despite continuous improvements in device design, surgical procedures, and wound care, biomaterial-associated infections (BAI) are still a major problem in modern medicine. Conventional antibiotic treatment often fails due to the low levels of antibiotic at the site of infection. The presence of biofilms on the biomaterial and/or the multidrug-resistant phenotype of the bacteria further impair the efficacy of antibiotic treatment. Removal of the biomaterial is then the last option to control the infection. Clearly, there is a pressing need for alternative strategies to prevent and treat BAI. Synthetic antimicrobial peptides (AMPs) are considered promising candidates as they are active against a broad spectrum of (antibiotic-resistant) planktonic bacteria and biofilms. Moreover, bacteria are less likely to develop resistance to these rapidly-acting peptides. In this review we highlight the four main strategies, three of which applying AMPs, in biomedical device manufacturing to prevent BAI. The first involves modification of the physicochemical characteristics of the surface of implants. Immobilization of AMPs on surfaces of medical devices with a variety of chemical techniques is essential in the second strategy. The main disadvantage of these two strategies relates to the limited antibacterial effect in the tissue surrounding the implant. This limitation is addressed by the third strategy that releases AMPs from a coating in a controlled fashion. Lastly, AMPs can be integrated in the design and manufacturing of additively manufactured/3D-printed implants, owing to the physicochemical characteristics of the implant material and the versatile manufacturing technologies compatible with antimicrobials incorporation. These novel technologies utilizing AMPs will contribute to development of novel and safe antimicrobial medical devices, reducing complications and associated costs of device infection.
Highlights
Martijn Riool 1, Anna de Breij 2, Jan W
Synthetic antimicrobial peptides (AMPs) are considered promising candidates as they are active against a broad spectrum of planktonic bacteria and biofilms
Antimicrobial peptides (AMPs)—effector molecules of the innate defense of animals, plants, and microorganisms (Zasloff, 2002; Hancock and Sahl, 2006)—have recently attracted considerable interest as agents that may subvert many of the problems related to biomaterial-associated infections (BAI), i.e., they display antimicrobial activity against bacteria resistant to antibiotics and residing within biofilms
Summary
Martijn Riool 1, Anna de Breij 2, Jan W. The number of bacteria required to cause an infection is significantly lower in the presence of a foreign body, such as a stitch or an implant, than when such devices are not present (Elek and Conen, 1957; James and Macleod, 1961; Noble, 1965; Taubler and Kapral, 1966; Zimmerli et al, 1982; Southwood et al, 1987). Another contributing factor is that the bacteria—often derived from the commensal skin flora or the hospital environment— can adhere to the foreign body, replicate, and form a biofilm from which they can invade the peri-implant tissues and cause an infection. Revision surgery is associated with high frequencies of infection due to extensive surgical procedures and more severe tissue damage
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