ABSTRACT
CONTENTS 14.1 Introduction ............................................................................................. 290 14.2 Uses of Indwelling Medical Devices ................................................... 291
14.2.1 Population Demographics ...................................................... 291 14.2.1.1 Inpatient vs. Outpatient ......................................... 293 14.2.1.2 Home-Based Care ................................................... 296
14.2.2 IMDs Related to Anatomic Location..................................... 296 14.2.2.1 Oral Cavity=Respiratory Tract .............................. 296 14.2.2.2 Skin............................................................................ 298 14.2.2.3 Genitourinary System............................................. 300
14.3 Consequences of Biofilms and IMDs................................................... 301 14.3.1 Consequences............................................................................ 301
14.3.1.1 Mortality and Morbidity........................................ 301 14.3.1.2 Outcomes and Cost................................................. 303
14.3.2 Pathogenic Organisms and Anatomical Location............... 306 14.3.2.1 Oral Cavity=Respiratory Tract .............................. 307 14.3.2.2 Skin............................................................................ 308 14.3.2.3 Genitourinary System............................................. 311
14.4 Biofilms and IMDs.................................................................................. 312 14.4.1 Introduction and Definitions.................................................. 312 14.4.2 Architecture and Structure ..................................................... 315 14.4.3 Physiology and Metabolism ................................................... 317 14.4.4 Physical Properties ................................................................... 318 14.4.5 Pathogenicity............................................................................. 320
14.5 Coatings and Anti-Infective Devices ................................................... 321 14.5.1 Antimicrobial Agents............................................................... 322 14.5.2 Anti-Infective Biomaterials=Polymers .................................. 323
14.5.3 Metals ......................................................................................... 324 14.5.4 Other........................................................................................... 324
14.5.4.1 Polymicrobial Peptides .......................................... 324 14.5.4.2 Antibiotic Lock Therapy ........................................ 325
14.6 Evidence-Based Benefits ........................................................................ 327 14.6.1 Strategies Designed to Prevent Biofilm Formation
in IMDs ...................................................................................... 327 14.6.1.1 Oral and VAP-Associated Studies ....................... 327 14.6.1.2 Wound Studies ........................................................ 329 14.6.1.3 Central Venous Catheter Studies ......................... 330 14.6.1.4 Urinary Catheter Studies ....................................... 331
14.6.2 Published Strategies Currently Being Developed and Evaluated ........................................................................... 333
14.7 Conclusions and the Future .................................................................. 333 References ........................................................................................................... 334
The use of indwelling medical devices and biomaterials has increased dramatically as a consequence of several factors, two of which are foremost: an aging population and the number of applications in new devices. However, this advance is complicated by the previously unrecognized form of microbial attachment: The biofilm. Today, biofilms are responsible for 50% of nosocomial infections.
