Biomaterial-associated infection

A wide variety of natural and synthetic materials have been used for biomedical applications. These include polymers, ceramics, metals, carbons, natural tissues, and composite materials (1). Of these materials, polymers remain the most widely used biomaterials. Polymeric materials have several advantages which make them very attractive as biomaterials (2). They include their versatility, physical properties, ability to be fabricated into various shapes and structures, and ease in surface modification. The long-term use of polymeric biomaterials in blood is limited by surface-induced thrombosis and biomaterial-associated infections (3,4). Thrombus formation on biomaterial surface is initiated by plasma protein adsorption followed by adhesion and activation of platelets (5,6). Biomaterial-associated infections occur as a result of the adhesion of bacteria onto the surface (7). The biomaterial surface provides a site for bacterial attachment and proliferation. Adherent bacteria are covered by a biofilm which supports bacterial growth while protecting them from antibodies, phagocytes, and antibiotics (8). Infections of vascular grafts, for instance, are usually associated with Pseudomonas aeruginosa Escherichia coli. Staphylococcus aureus, and Staphyloccocus epidermidis (9). 

Since the interactions lea ng to surface-induced thrombosis and biomaterial-associated infections occur at the biomaterial-blood interface, appropriate surface modification is beneficial in improving the blood compatibility of biomaterials (10). 

In the introductory part of this chapter, it is mentioned that in various systems and applications, bioadhesion is an unwanted phenomenon. Different strategies may be taken to prevent or suppress (microbial) cell adhesion and biofilm formation. Coating the surface with antimicrobial agents such as silver nanoparticles may have some effect. However, the hazard of release of such toxic particles in the body, product, or enviromnent puts severe restrictions on their use. Furthermore, prophylactic supply of antibiotics to treat biomaterials associated infections is in most cases highly unsuccessful, because in biofilms bacteria tend to be resistant against antibiotics. 

Bacterial adhesion is the altical step in the pathogenesis of biomaterial-associated infection and is critically inflnenced by numerous variables including surface properties of biomaterials, the nature of the environment, and the bacterial cell surface. In addition, adsorbed proteins play an important role in bacteria-surface interactions. One strategy for the development of antibacterial polyurethanes has focused on... 

Neoh KG, Shi ZL, Kang ET. In Moriarty TF, Zaat SAJ, Busscher HJ, editors. Biomaterials associated infection. Springer New York 2013. p. 405-32. [Chapter 16]. 

Busscher HJ, van der Mei HC, Subbiahdoss G, Jutte PC, van den Dungen JJ, Zaat SA, Schultz MJ, Grainger DW. Biomaterial-associated infection locating the finish line in the race for the surface. Sci Transl Med. 2012 4 153rvl0. 

Moriarty, T.F., Zaat, S.A.J., Busscher, H.J. Biomaterials Associated Infection. Immunological Aspects and Antimicrobial Strategies. Springer, Heildelberg (2013). ISBN 978-1-4614-1030-0... 

Boelens, J., Van Der Poll, T., Zaat, S., Murk, J., Weening, J., Dankerf J., 2000b. Interleukin-1 receptor type I gene-deficient mice are less susceptible to Staphylococcus epidermidis biomaterial-associated infection than are wild-type mice. Infect Immun. 68, 6924-6931. 

Biomaterials are materials foreign to the human body that are used in medicine to replace, support or restore body function. Applications range from central venous and urinary catheters to more complex devices such as prosthetic joints and heart valves. The risk of biomaterial centered infection (BCI) is a key factor limiting their use [1]. The incidence of this type of infections varies for each application for instance 4% for hip prostheses [2] and 10-20% for urinary catheters (see Table 1). In BCI microorganisms are present in close association with the biomaterial surface forming a so-called biofilm. Different species of microorganisms are found in BCI that are often commen-... 

The predominant mechanism of biofilm accumulation in staphylococci involves polysaccharide intercellular adhesin (PIA) [60-66], S. epidermidis strains lacking this adhesin are also regularly isolated from biomaterial-related infections, a fact which prompted a search for an alternative, PIA-independent accumulation mechanism [51, 52, 60-62, 67, 68], The responsible molecule was identified as accumulation associated protein, Aap [69-71], and there may also be a role for additional proteinaceous intercellular adhesins [52], Aap has a similar-acting homolog, SasG, in S. aureus [72], adding to the accumulating evidence that proteinaceous intercellular adhesins are also of importance in S. aureus biofilm formation and device-related infection [52, 72-74],... 

Biomaterials and medical-device associated infections Edited by L Barnes and I. R. Cooper... 

Delaviz Y, Santerra JP, Cvitkovitch DG. In Cooper IR, Barnes L, editors. Biomaterials and medical device associated infections. Woodhead Publishing Cambridge, UK. 2015. p. 223-54. 

Jiang, B., Li, B. (2009). Polypeptide nanocoatings for preventing dental and orthopaedic device-associated infection pH-induced antibiotic capture, release, and antibiotic efficacy. Journal of Biomedical Materials Research Part B Applied Biomaterials, 88B(2), 332-338. 

Kazemzadeh-Narbat, M., Lai, B.F.L., Ding, C., Kizhakkedathu, J.N., Hancock, R.E.W, Wang, R., 2013. Multilayered coating on titanium for controlled release of antimicrobial peptides for the prevention of implant-associated infections. Biomaterials 34,5969-5977. http //dx.doi. org/10.1016/j.biomaterials.2013.04.036. 

---