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Home arrow Communication arrow Biofilms and Implantable Medical Devices: Infection and Control

Healthcare-associated infections

HCAIs are infections that result from direct medical care or treatment in hospital (Suleman et al., 2014). The most common HCAI are the VAP, central line-associated septicemia, urinary tract infection, Clostridium difficile infection, and surgical site infection. These infections have been extensively studied, and some bacteria and fungi have been associated with HCAI. In clinical settings, biofilm growth on urinary catheter, ventricular drains, mammary implants, and cochlear implants has been observed. In fact, colonization of indwelling medical devices is around 50% of the HCAIs stated in the United States (Humphreys and McBain, 2014). Furthermore, infections that involve biofilms indwelling medical devices are estimated to be 40% in the case of ventricular-assisted devices, 4% in cardiac implants, 2% in the case of joint prosthetics, and almost 100% in the case of long-term urinary catheterization (>28 days) (Donlan, 2001b).

Most common contamination in medical devices

Infections associated with medical devices pose an enormous economic burden on hospital services and increase the incidence of patient morbidity and mortality (Donlan, 2008).

The initial contamination usually takes place with a small number of microorganisms that come into contact with the medical device through the patients’ or healthcare workers’ skin, contaminated water, or other external sources (von Eiff et al., 2005). Nearly 80% of the bacteria involved in infections associated with medical devices are S. epidermidis. This bacterium together with S. aureus are the most common microorganisms associated with biofilm infections in medical materials, and are considered as the major source for HAI (Percival et al., 2015). The most common microorganism associated with each medical device is presented in Table 4.2.

Table 4.2 Commonly isolated microorganisms from biofilms associated with indwelling medical devices

Medical device



Central venous catheter

Staphylococcus epidermidis, Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecalis

Donlan (2001b) and Cooper et al. (2014)

Urinary catheter

S. epidermidis, E. faecalis,

E. coli, Proteus mirabilis,

P. aeruginosa, K. pneumoniae, Acinetobacter baumannii, and C. albicans

Donlan (2001b), Percival et al. (2015), Singhai et al. (2012), and

Adam et al. (2002)

Endotracheal tubes

P. aeruginosa, S. aureus,

P. mirabilis, K. pneumoniae, Enterobacter, E. faecalis, Acinetobacter spp., and the fungus C. albicans

Adair et al. (1999) and Bauer et al. (2002)

Enteral feeding

Enterococci, staphylococci, Pseudomonas, Bacilli, and Candida spp.

Dautle et al. (2002) and Mehall et al. (2002)

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