Biomaterial-Associated Infection: Pathogenesis and Prevention

The use of medical devices, such as urinary stents, catheters, artificial heart valves, prosthetic joints and other implants, collectively often referred to as “biomaterials” has increased dramatically over the past century, and has become a major part of modern medicine and our daily life. With the aging society, the higher demand on these devices to restore function and quality of life, combined with the ever improving technology within the medical field, the problem of biomaterial-associated infection (BAI) is expected to increase. The most common causative microorganisms in BAI are Staphylococcus aureus, a major pathogen in wound infections, and Staphylococcus epidermidis, the harmless skin commensal. Depending on the type of device and location of application, other pathogens such as coagulase-negative staphylococci, enterococci, streptococci, Propionibacterium acnes and yeast can also cause BAI. Prevention of BAI is a challenging problem, in particular due to the increased risk of resistance development associated with current antibiotic-based strategies. Here we showed the evidence of biofilms as a source for peri-implant tissue colonization, clearly showing the importance of preventive measures to be able to act both against implant and tissue colonization. Subsequently, we described different strategies to prevent BAI and other difficult-to-treat biofilm infections. We conclude that future research should focus on the development of combination devices with both anti-fouling or contact-killing capacities—to protect the implant—and controlled release of an antimicrobial agent to protect the surrounding tissue.