Abstract
Healthcare acquired infections (HAI's) are a worldwide problem that can be exacerbated by surgery and the implantation of polymeric medical devices. The use of polymer based medical devices which incorporate antimicrobial strategies are now becoming an increasingly routine way of trying to prevent the potential for reduce chronic infection and device failure. There are a wide range of potential antimicrobial agents currently being incorporated into such polymers. However, it is difficult to determine which antimicrobial agent provides the greatest infection control. The economics of replacing current methods with impregnated polymer materials further complicates matters. It has been suggested that the use of a holistic system wide approach should to be developed around the implantation of medical devices which minimises the potential risk of infection. However, the use of such different approaches is still being developed. The control of such infections is important for individual patient health and the economic implications for healthcare services.
Highlights
The association between microbial contamination and its role in the potential to lead to pathogenic infection is well established (Ashbolt, 2004; Weber and Rutala, 2013; Kenters et al, 2015; Marra et al, 2017)
Whilst almost all pathogens have the potential to become problematic in hospitalised patients, the aetiology of most Healthcare acquired infections (HAI's) can be traced back to a few bacterial species namely Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, coagulase-negative staphylococci (CoNS) and Enterococcus spp. (Martin et al, 1989; Emori and Gaynes, 1993; Bereket et al, 2012)
A pre-infected in vivo central venous catheter animal model to demonstrate that chitosan coated polyethylene catheters inhibited biofilm formation, whilst significantly reducing the microbial burden when compared with a control over 24 h (Rabea et al, 2003)
Summary
The association between microbial contamination and its role in the potential to lead to pathogenic infection is well established (Ashbolt, 2004; Weber and Rutala, 2013; Kenters et al, 2015; Marra et al, 2017). (predominately E. faecalis and E. faecium) (Martin et al, 1989; Emori and Gaynes, 1993; Bereket et al, 2012) For indwelling devices, it is often the location of the implant that dictates the most likely colonising pathogen. Microbial resistance to nearly every current antibiotic has been observed (Jones, 2001) This was highlighted by the reporting of over 2 million AMR infections in the USA in 2013 alone. The use of synthetic polymers in a medical capacity began with the introduction of polypropylene (PP), nylon, and polyester sutures in World War II (Gilbert, 1999; Dumitriu, 2001). There has been the development of ‘smart’ polymers that can react to the use of pH, temperature, magnetic field or light for use in specific applications (Aguilar and Roman, 2014; Weems et al, 2017)
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