Bacterial infection from medical devices is a major problem and accounts for an increasing number of deaths as well as high medical costs. Many different strategies have been developed to decrease the incidence of medical device related infection. One way to prevent infection is by modifying the surface of the devices in such a way that no bacterial adhesion can occur. This requires modification of the complete surface with, mostly, hydrophilic polymeric surface coatings. These materials are designed to be non-fouling, meaning that protein adsorption and subsequent microbial adhesion are minimized. Incorporation of antimicrobial agents in the bulk material or as a surface coating has been considered a viable alternative for systemic application of antibiotics. However, the manifestation of more and more multi-drug resistant bacterial strains restrains the use of antibiotics in a preventive strategy. The application of silver nanoparticles on the surface of medical devices has been used to prevent bacterial adhesion and subsequent biofilm formation. The nanoparticles are either deposited directly on the device surface, or applied in a polymeric surface coating. The silver is slowly released from the surface, thereby killing the bacteria present near the surface. In the last decade there has been a surplus of studies applying the concept of silver nanoparticles as an antimicrobial agent on a range of different medical devices. The main problem however is that the exact antimicrobial mechanism of silver remains unclear. Additionally, the antimicrobial efficacy of silver on OPEN ACCESSPolymers 2011, 3 341 medical devices varies to a great extent. Here we will review existing antimicrobial coating strategies and discuss the use of silver or silver nanoparticles on surfaces that are designed to prevent medical device related infections.

We report here metal-free strategies using organocatalysis based on supramolecular recognition for the ring-opening polymerization (ROP) of several cyclic phosphate monomers (CPMs) by a variety of organocatalysts such as 1,8-diazabicyclo[5.4.0]undec-7-ene (DBU), 1,5,7-triazabicyclo[4.4.0]undec-5-ene (TBD), and a bicomponent thiourea–tertiary amine catalyst. Each of these catalysts is efficient to produce linear polyphosphoesters (PPEs) from CPMs but with different sensitivity toward transesterification side reactions. The strong basicity of DBU is sufficient to activate an alcohol initiating the polymerization in the absence of any other cocatalyst. Nevertheless, side chain transfer reactions leading to branched and/or cyclic polymeric structures are observed, especially for high monomer conversion. Unlike DBU, TBD is a dual catalyst activating both the alcohol and the monomer. This dual activation allows shorter polymerization time, but SEC analyses of polyphosphates reveal bimodal molecular weight distribution due to chains coupling. Finally, a mixture of DBU and thiourea (TU) appears by far the most efficient catalyst to carry out fast and controlled polymerization while minimizing transesterification reactions, even at near-complete conversion. Compared with polymerizations carried out with Sn(Oct)2 as a metal catalyst, the control of polymerization is much better so that it is possible to prepare polyphosphoesters (PPEs) with molecular weight close to 70 000 g mol–1 and polydispersity index below 1.10. Simultaneous activation by TU of both CPMs and the alcohol group of the initiator by DBU proves to be an effective and robust ROP catalytic system to synthesize polymers with predictable molecular weight and narrow polydispersity. The chain extension experiments through the use of hydroxy end-capped PPEs as macroinitiators confirm the controlled/living nature of the DBU/TU-catalyzed ROP of CPMs and pave the way to the synthesis of block copolymers based on polyphosphates.

Synthetic polymeric microspheres find application in a wide range of medical applications. Among other applications, microspheres are being used as bulking agents, embolic- or drug-delivery particles. The exact composition of the spheres varies with the application and therefore a large array of materials has been used to produce microspheres. In this review, the relation between microsphere synthesis and application is discussed for a number of microspheres that are used for different treatment strategies.

Biomaterial surfaces may be modified to reduce bacterial adhesion. The susceptibility in mice to Staphylococcus epidermidis infection in tissue surrounding the commonly used catheter materials-silicon elastomer (SE), polyamide (PA), and their surface-modified polyvinylpyrrolidone (PVP)-grafted derivatives, SE-PVP and PA-PVP, respectively-was assessed. Abscesses developed around SE-PVP. Around SE, PA, and PA-PVP catheters, no signs of infection were observed, although mice carrying PA-PVP developed septicemia after 14-21 days. S. epidermidis was cultured from the tissue surrounding PA-PVP segments. Cells around PA-PVP segments containing large numbers of bacteria were identified as macrophages by use of immunohistochemistry and electron microscopy. This persistence of intracellular bacteria was also observed around SE-PVP, SE, and PA catheters, although to a lesser extent. The cytokine profiles around the 4 materials were different. Implanted biomaterial induces an inflammatory response favorable to the persistence of S. epidermidis. Intracellular persistence of bacteria inside macrophages may be a pivotal process in the pathogenesis of biomaterial-associated infection.

No abstract

No abstract

No abstract

No abstract