Abstract
Bacterial infection from medical devices is a major problem and accounts for an increasing number of deaths as well as high medical costs. Many different strategies have been developed to decrease the incidence of medical device related infection. One way to prevent infection is by modifying the surface of the devices in such a way that no bacterial adhesion can occur. This requires modification of the complete surface with, mostly, hydrophilic polymeric surface coatings. These materials are designed to be non-fouling, meaning that protein adsorption and subsequent microbial adhesion are minimized. Incorporation of antimicrobial agents in the bulk material or as a surface coating has been considered a viable alternative for systemic application of antibiotics. However, the manifestation of more and more multi-drug resistant bacterial strains restrains the use of antibiotics in a preventive strategy. The application of silver nanoparticles on the surface of medical devices has been used to prevent bacterial adhesion and subsequent biofilm formation. The nanoparticles are either deposited directly on the device surface, or applied in a polymeric surface coating. The silver is slowly released from the surface, thereby killing the bacteria present near the surface. In the last decade there has been a surplus of studies applying the concept of silver nanoparticles as an antimicrobial agent on a range of different medical devices. The main problem however is that the exact antimicrobial mechanism of silver remains unclear. Additionally, the antimicrobial efficacy of silver on medical devices varies to a great extent. Here we will review existing antimicrobial coating strategies and discuss the use of silver or silver nanoparticles on surfaces that are designed to prevent medical device related infections.
Highlights
It is acknowledged that medical device related infections account for a substantial morbidity as well as causing a sharp increase in health-care costs [1,2,3,4]
In this review we describe the main strategies that have been employed to prevent medical device related infection
Since the discovery of penicillin by Fleming in 1928 [55], the systemic application of a wide variety of antibiotics has been the treatment of choice for bacterial infections, those associated with implanted medical devices
Summary
It is acknowledged that medical device related infections account for a substantial morbidity as well as causing a sharp increase in health-care costs [1,2,3,4]. An increase in SSI was observed for mastectomy with immediate placement of a breast implant (12.4%) when compared to more conventional mastectomy interventions (4.4% to 6.2%) [7] It shows that SSI can vary considerably from study to study and that implantation of a synthetic device is associated with a higher rate of infection. It is estimated that in the United States alone at least 80,000 catheter related bloodstream infections (CRBSI) occur annually in intensive care units These CRBSIs are associated with 24,000 patient deaths and increased health care costs ranging from approximately $10,000 to $63,000 per case. Because the health insurance companies have enlisted medical device related infections as preventable, Medicare and Medicaid may no longer reimburse the costs associated with these infections in the U.S in the near future [12,13]. An attempt will be made to describe a possible mode of action of silver as an antibiotic agent using the limited data available on this subject
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