Abstract
Over the years, there has been an increasing number of cardiac and orthopaedic implanted medical devices, which has caused an increased incidence of device-associated infections. The surfaces of these indwelling devices are preferred sites for the development of biofilms that are potentially lethal for patients. Device-related infections form a large proportion of hospital-acquired infections and have a bearing on both morbidity and mortality. Treatment of these infections is limited to the use of systemic antibiotics with invasive revision surgeries, which had implications on healthcare burdens. The purpose of this review is to describe the main causes that lead to the onset of infection, highlighting both the biological and clinical pathophysiology. Both passive and active surface treatments have been used in the field of biomaterials to reduce the impact of these infections. This includes the use of antimicrobial peptides and ionic liquids in the preventive treatment of antibiotic-resistant biofilms. Thus far, multiple in vivo studies have shown efficacious effects against the antibiotic-resistant biofilm. However, this has yet to materialize in clinical medicine.
Highlights
The use of orthotics and prosthetics medical devices has grown exponentially over the past half-century, ameliorating patients’ quality of life (QoL)
S. aureus quorum-sensing system is encoded by Agr, which regulates the production of virulence factors in biofilm-associated infections, such as endocarditis and osteomyelitis [20]
The detachment phase is characterized by concomitant expression of different saccharolytic enzymes (i.e., N-acetyl-heparosan lyase, alginate lyase, hyaluronidase, βlattamasi, etc.), which help the attached microbial colonies to release from the surface; and along with adhesins, extracellular appendages up-regulation let the bacteria move toward a new site [17]
Summary
The use of orthotics (cardiac pacemakers, defibrillators, and stents) and prosthetics (heart valves, fracture fixation, joint prostheses) medical devices has grown exponentially over the past half-century, ameliorating patients’ quality of life (QoL). The lack of a universal surface treatment suitable for any microbial strain and implant; a short-lasting (i.e., over 2 weeks) and microbial strain-dependent antifouling feature; along with difficult-to-predict long-term effects after antibacterial coatings depletion, are some of the issues limiting the efficacy antimicrobial passive and active implants’ surface modifications in clinical practice. Comparing to the existing reviews, the present work stands out for reporting the last 5-years advancements in implants’ surfaces antimicrobial modification strategies, by highlighting the dual antimicrobial and regenerative potential of promising therapeutic biomaterials (i.e., ionic liquids), in the framework of managing antibiotic-resistance biofilm in cardiac and orthopaedic indwelling devices-associated infections. Deregulation of host-commensal bacteria homeostasis in the presence of a foreign body, such as an indwelling implant, may result in a pathogenic biofilm formation and causing the onset of MDIs. Among the several microbial strains. P. gingivalis, A. actinomycetemcomitans, B. forsythus, T. denticola, P. nigrescens, P. micros, F. nucleatum (30–40%)
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