Modification of the surfaces of medical devices to prevent microbial adhesion and biofilm formation

Background: The development of devices with surfaces that have an effect against microbial adhesion or viability is a promising approach to the prevention of device-related infections. Aim: To review the strategies used to design devices with surfaces able to limit microbial adhesion and/or growth. Methods: A PubMed search of the published literature. Findings: One strategy is to design medical devices with a biocidal agent. Biocides can be incorporated into the materials or coated or covalently bonded, resulting either in release of the biocide or in contact killing without release of the biocide. The use of biocides in medical devices is debated because of the risk of bacterial resistance and potential toxicity. Another strategy is to modify the chemical or physical surface properties of the materials to prevent microbial adhesion, a complex phenomenon that also depends directly on microbial biological structure and the environment. Anti-adhesive chemical surface modifications mostly target the hydrophobicity features of the materials. Topographical modifications are focused on roughness and nanostructures, whose size and spatial organization are controlled. The most effective physical parameters to reduce bacterial adhesion remain to be determined and could depend on shape and other bacterial characteristics. Conclusions: A prevention strategy based on reducing microbial attachment rather than on releasing a biocide is promising. Evidence of the clinical efficacy of these surface-modified devices is lacking. Additional studies are needed to determine which physical features have the greatest potential for reducing adhesion and to assess the usefulness of antimicrobial coatings other than antibiotics. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.