Frontiers in Clinical Drug Research-Anti Infectives

Volume: 4

Prevention and Eradication of Biofilm in Medical Indwelling Devices

Author(s): Maria Manuel Azevedo, Luis Cobrado, Ana Silva-Dias, Cidalia Pina- Vaz and Acacio Goncalves Rodrigues

Pp: 204-248 (45)

DOI: 10.2174/9781681084879117040008

* (Excluding Mailing and Handling)

Abstract

The use of medical indwelling devices (MID) became a hallmark in medicine during the last few decades. While it represents a considerable progress in terms of chances of patient survival, several associated drawbacks demand continuous research in terms of optimization of such devices or of its use in order to cope with complications, which could be life threatening. Notably infection remains one of the most inherent complications associated with MIDs, constituting the most feared threat. Very frequently, it demands MID replacement, often leading to its lost, to prolonged patient hospitalization and, ultimately, to patient death. In any case, it represents a serious burden to healthcare systems in terms of allocated resources and financial costs. The formation of biofilm became the paradigm of MID infection. Independently of the nature of such devices, following its placement or implantation infection remains hard or impossible to control with common antibiotics. In fact, antibiotic drugs hardly penetrate the polymeric matrix of biofilm, which allows organisms to evade its activity. Moreover, organisms in biofilm display increased antibiotic resistance, in comparison to its planktonic counterparts. While diverse preventive strategies have been attempted, with variable success, fewer options remain available once overt infection develops, apart from device removal. Nevertheless novel alternatives have been proposed and recent research efforts with specific devices have provided encouraging results. Our research team has been addressing this problematic from a clinical perspective and, in particular, from a laboratorial point of view, conducting both in vitro and in vivo studies in biofilm infection models. The authors propose to conduct an extensive review and discussion of the literature available concerning biofilm involvement in MID infection, having as main focus the eradication of biofilm at the surface of MID, apart from prevention of the initial steps of its formation. While a large variety of devices will be discussed, like central venous catheters, prosthetic or cardiovascular implants, special consideration will be dedicated to high value devices such as heart pace-makers and cerebral stimulators, attending to the direct high costs associated to its lost following infection.


Keywords: Antibiotic resistance, Aging population, Biofilms, Bloodstream infections, Central venous catheters, Cardiovascular implants, Cerebral stimulators, Candidiasis, Cystic fibrosis, Chronic wounds, Chitosans, Cerium nitrate, Central line associated bloodstream infections, Chronic infections, Chronic rhinosinusitis, Endocarditis, Electrical dialyzers, Enterobacteriaceae, Fungal infections, Heart pacemakers, Healthcare related infections, Hamamelitannin, Immunocompromised patients, Implantable cardiac devices, Medical indwelling devices, Nosocomial bacteremia, Osteomyelitis, Polyethyleneimine, Periodontitis, Polymicrobial biofilms, Prosthesis joint infection, Prosthetic implants, Staphylococcus aureus, Staphylococcus epidermidis, Sepsis, Trauma patients.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59884719 and j.to_ip >=59884719 )) and ((j.from_date <= 1740459902 and j.to_date >= 1740459902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 11121) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59884719 and j.to_ip >=59884719 )) and ((j.from_date <= 1740459902 and j.to_date >= 1740459902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 11121) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59884719 and j.to_ip >=59884719 )) and ((j.from_date <= 1740459902 and j.to_date >= 1740459902 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 11121)
      890μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 2275 and `b`.`banner_from_date` <= 1740459902 and `b`.`banner_to_date` >= 1740459902 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.56msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 2275
      • 3: 1740459902
      • 4: 1740459902
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='e2d5c75bac0b9e71c6efcec5291b1fa5'
      310μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    36Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        9PX1RQ3mRPxvdsTfxRvpj1IUVhoSZYT2XaP9PkBn
        uc_cart_id
        e2d5c75bac0b9e71c6efcec5291b1fa5
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/11121" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/11121
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
        array:1 [ "wayfindertarget" => null ]
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Tue, 25 Feb 2025 05:05:02 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Ik12aEJKbFFmM1k3V0hjZFdRSCtHOUE9PSIsInZhbHVlIjoidmpUNG5mTGlmSktMMVlnOFlKcFp0ZUc2cnJ4Qkw1OWFuOE9pQXQ0c0ZkZ0l6VE9FTXNYdnpqMSszMXZmejNEZ3FxU1ZrM01BaTJjZHNsSWd6N2Y5R0JVNHFlNDZFSUx2cUZmeGZQNnBiQ3lrOXFqaEM2dXRaemE0ZWJjUnljK1EiLCJtYWMiOiI4NTY2ZmZhOGEwYzUyYTZhZjBiY2JiOTgyMmJmNjFlMjYwNTUxYmM2NDE3ZWVjMjY3ZGY0ZDBmODE5YWY2ZTY2IiwidGFnIjoiIn0%3D; expires=Thu, 27 Feb 2025 17:05:02 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6Ik12aEJKbFFmM1k3V0hjZFdRSCtHOUE9PSIsInZhbHVlIjoidmpUNG5mTGlmSktMMVlnOFlKcFp0ZUc2cnJ4Qkw1OWFuOE9pQXQ0c0ZkZ0l6VE9FTXNYdnpqMSszMXZmejNEZ3FxU1ZrM" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkIySmplZzdPN0NGeEQwUDBBN0c5dUE9PSIsInZhbHVlIjoicGdzSWdvTEREYVM0LzNqS1MxcU04bzA2bkVjSUEvU1hDRUVLUVNrQ2lUV3k0bWFzdklJT0t5dkpoZFFUbXdHLzFMN0VzbTRnSytSMTVSYWxHZkVXZGNQNUdKelBtOXRYT210WlhSV1NCRHNNRUpZdXdhWXM4VVViZFYrZTlSVDMiLCJtYWMiOiIzNTc5MzExNzZkMjI2NzRhMmIxMDBlN2MyN2FiMzkyZTRjODgwODEwM2UxNGUxMmFjNzliMjIyOTE2ZTFlMDUwIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IkIySmplZzdPN0NGeEQwUDBBN0c5dUE9PSIsInZhbHVlIjoicGdzSWdvTEREYVM0LzNqS1MxcU04bzA2bkVjSUEvU1hDRUVLUVNrQ2lUV3k0bWFzdklJT0t5dkp" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6Ik12aEJKbFFmM1k3V0hjZFdRSCtHOUE9PSIsInZhbHVlIjoidmpUNG5mTGlmSktMMVlnOFlKcFp0ZUc2cnJ4Qkw1OWFuOE9pQXQ0c0ZkZ0l6VE9FTXNYdnpqMSszMXZmejNEZ3FxU1ZrM01BaTJjZHNsSWd6N2Y5R0JVNHFlNDZFSUx2cUZmeGZQNnBiQ3lrOXFqaEM2dXRaemE0ZWJjUnljK1EiLCJtYWMiOiI4NTY2ZmZhOGEwYzUyYTZhZjBiY2JiOTgyMmJmNjFlMjYwNTUxYmM2NDE3ZWVjMjY3ZGY0ZDBmODE5YWY2ZTY2IiwidGFnIjoiIn0%3D; expires=Thu, 27-Feb-2025 17:05:02 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6Ik12aEJKbFFmM1k3V0hjZFdRSCtHOUE9PSIsInZhbHVlIjoidmpUNG5mTGlmSktMMVlnOFlKcFp0ZUc2cnJ4Qkw1OWFuOE9pQXQ0c0ZkZ0l6VE9FTXNYdnpqMSszMXZmejNEZ3FxU1ZrM" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkIySmplZzdPN0NGeEQwUDBBN0c5dUE9PSIsInZhbHVlIjoicGdzSWdvTEREYVM0LzNqS1MxcU04bzA2bkVjSUEvU1hDRUVLUVNrQ2lUV3k0bWFzdklJT0t5dkpoZFFUbXdHLzFMN0VzbTRnSytSMTVSYWxHZkVXZGNQNUdKelBtOXRYT210WlhSV1NCRHNNRUpZdXdhWXM4VVViZFYrZTlSVDMiLCJtYWMiOiIzNTc5MzExNzZkMjI2NzRhMmIxMDBlN2MyN2FiMzkyZTRjODgwODEwM2UxNGUxMmFjNzliMjIyOTE2ZTFlMDUwIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IkIySmplZzdPN0NGeEQwUDBBN0c5dUE9PSIsInZhbHVlIjoicGdzSWdvTEREYVM0LzNqS1MxcU04bzA2bkVjSUEvU1hDRUVLUVNrQ2lUV3k0bWFzdklJT0t5dkp" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "9PX1RQ3mRPxvdsTfxRvpj1IUVhoSZYT2XaP9PkBn" "uc_cart_id" => "e2d5c75bac0b9e71c6efcec5291b1fa5" "_previous" => array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/11121" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-25 05:05:02GET/chapter/111211121938