Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Avenida Prof. Gama Pinto, 1649-003 Lisboa, Portugal.
Centro Interdisciplinar de Estudos Educacionais (CIED), Escola Superior de Educação de Lisboa, Instituto Politécnico de Lisboa, Campus de Benfica do IPL, 1549-003 Lisboa, Portugal.
Adv Colloid Interface Sci. 2020 Oct;284:102230. doi: 10.1016/j.cis.2020.102230. Epub 2020 Aug 6.
The use of invasive medical devices is becoming more common nowadays, with catheters representing one of the most used medical devices. However, there is a risk of infection associated with the use of these devices, since they are made of materials that are prone to bacterial adhesion with biofilm formation, often requiring catheter removal as the only therapeutic option. Catheter-related urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) are among the most common causes of healthcare-associated infections (HAIs) worldwide while endotracheal intubation is responsible for ventilator-associated pneumonia (VAP). Therefore, to avoid the use of biocides due to the potential risk of bacterial resistance development, antifouling strategies aiming at the prevention of bacterial adherence and colonization of catheter surfaces represent important alternative measures. This review is focused on the main strategies that are able to modify the physical or chemical properties of biomaterials, leading to the creation of antiadhesive surfaces. The most promising approaches include coating the surfaces with hydrophilic polymers, such as poly(ethylene glycol) (PEG), poly(acrylamide) and poly(acrylates), betaine-based zwitterionic polymers and amphiphilic polymers or the use of bulk-modified poly(urethanes). Natural polysaccharides and its modifications with heparin, have also been used to improve hemocompatibility. Recently developed bioinspired techniques yielding very promising results in the prevention of bacterial adhesion and colonization of surfaces include slippery liquid-infused porous surfaces (SLIPS) based on the superhydrophilic rim of the pitcher plant and the Sharklet topography inspired by the shark skin, which are potential candidates as surface-modifying approaches for biomedical devices. Concerning the potential application of most of these strategies in catheters, more in vivo studies and clinical trials are needed to assure their efficacy and safety for possible future use.
如今，侵入性医疗器械的使用越来越普遍，其中导管是使用最广泛的医疗器械之一。然而，由于这些器械由易于细菌黏附并形成生物膜的材料制成，因此在使用过程中存在感染的风险，通常需要将导管移除作为唯一的治疗选择。导管相关尿路感染（CAUTIs）和中心静脉导管相关血流感染（CLABSIs）是全球范围内最常见的医疗保健相关感染（HAIs）之一，而气管内插管则是呼吸机相关性肺炎（VAP）的罪魁祸首。因此，为了避免由于细菌耐药性发展的潜在风险而使用生物杀灭剂，针对导管表面细菌黏附和定植的防污策略代表了重要的替代措施。本综述重点介绍了能够改变生物材料物理或化学性质从而创建抗黏附表面的主要策略。最有前途的方法包括用亲水性聚合物（如聚乙二醇（PEG）、聚丙烯酰胺和聚丙烯酸）、甜菜碱型两性离子聚合物和两亲聚合物涂覆表面，或使用整体改性的聚（尿烷）。天然多糖及其与肝素的修饰也被用于改善血液相容性。最近开发的仿生技术在预防细菌黏附和表面定植方面取得了非常有前景的结果，包括基于猪笼草超亲水边缘的滑液注入多孔表面（SLIPS）和受鲨鱼皮启发的 Sharklet 拓扑结构，它们是作为生物医学器械表面改性方法的潜在候选者。关于这些策略在导管中的潜在应用，需要更多的体内研究和临床试验来确保它们的功效和安全性，以便未来可能使用。
