Antimicrobial medical devices in preclinical development and clinical use

Abstract

Medical devices are increasingly used worldwide for an expanding -repertoire of patient clinical needs. Biomaterials and medical device designs have become progressively more complex to accommodate diverse demands for performance and safety in vivo. While a majority of these implants satisfy their clinical expectations with safety and efficacy in their specific applications, a minority of implants induce serious adverse events with substantial health and economic consequences. One recognized challenge is the growing clinical problem with implant-associated infections. Increasing number and types of implants used in patients have resulted in increasing numbers of biomaterial-associated infections. Researchers and medical device manufacturers have responded to this challenge with intensified attention to innovating device designs, surgical implantation protocols, and biomaterials to minimize infection opportunities. Medical devices with claims to limit microbial adhesion and colonization using combinations of pharmacological, topological, and materials chemistry approaches have been brought into clinical use with the intent of reducing device-related infections. Many types of catheters, stents, orthopedic devices, contact lenses, surgical meshes, shunts, sutures, cardiovascular replacements, and many other device categories offer antimicrobial enhancements. Approaches include different biomaterials chemistries that intrinsically resist microbial colonization or that deter active growth on contact, surface modifications that produce topologies observed to limit pathogen attachment, medicinal, antiseptic or bioactive coatings, direct antimicrobial attachment to surfaces, or drug impregnation within the biomaterial, and extended release strategies that control antimicrobial agent release from the device over time after implantation.