chapter  15
34 Pages

Infection-Resistant Implantable Devices: Biofilm Problems and Design Strategies

WithAnthony W. Smith, Semali Perera

CONTENTS 15.1 Introduction ............................................................................................. 339 15.2 Medical Devices and Biofilms .............................................................. 340

15.2.1 Biofilm Resistance: Overview ................................................. 341 15.2.2 Biofilm Resistance: Possible Mechanisms............................. 341

15.3 Antibiofilm Approaches: Design Strategies ....................................... 343 15.3.1 Material Modification to Prevent Biofilm Formation ......... 344 15.3.2 Polymer-Based Antimicrobial Delivery Systems................. 346

15.3.2.1 Poly(glycolic acid) .................................................... 346 15.3.2.2 Poly(lactic acid) ........................................................ 347 15.3.2.3 Poly(lactide-co-glycolide)........................................ 347 15.3.2.4 Poly(caprolactone).................................................... 348

15.3.3 Importance of Early Treatment............................................... 349 15.3.4 Implantable Matrices, Microparticles, Fibrous Scaffolds,

and Thermoreversible Gels ..................................................... 349 15.4 State-of-the-Art Prosthetic Implants .................................................... 352 15.5 Implants for Cancer Treatment ............................................................ 354

15.5.1 Commercial Cancer Implants ................................................. 356 15.5.2 Design of Antibacterial Biodegradable Cancer Implants... 357

15.6 Discussion and Future Aspects ............................................................ 364 Acknowledgments ............................................................................................. 365 References ........................................................................................................... 365

Advancements in medical and surgical technologies mean that indwelling devices are being used increasingly, either as permanent implants such as prosthetic joints and coronary arterial stents or for maintaining access to

sites in the short term such as venous and urinary catheters. Increasing attention is being focussed on implantable matrices as devices to control the delivery of drugs to a particular target site. Inevitably, implanted devices of whatever composition provide an unwanted focus for infection through development of microbial biofilms. Biofilms represent a significant clinical challenge and frequently result in device failure. Here, we review the clinical challenge posed by microbial biofilms and present some of the strategies that have been proposed to reduce or prevent biofilm formation on implantable devices.