JAC Advance Access originally published online on March 31, 2004
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Journal of Antimicrobial Chemotherapy (2004) 53, 778-782
© 2004 The British Society for Antimicrobial Chemotherapy
Mode of action of an antimicrobial biomaterial for use in hydrocephalus shunts
Biomaterials-Related Infection Group, Division of Orthopaedic and Accident Surgery, C Floor West Block, University Hospital, Nottingham NG7 2UH, UK
Received 15 August 2003; returned 12 November 2003; revised 12 January 2004; accepted 13 February 2004
Objectives: Infection remains a major complication of shunting for hydrocephalus. The causative bacteria, mainly staphylococci, gain access to the shunt at operation and colonize the shunt tubing. This leads to biofilm development requiring shunt removal. As there is no clear evidence to support antibiotic prophylaxis, we have developed an impregnated antimicrobial shunt material. This study aimed to elucidate its mode of action in terms of bacterial adherence and killing kinetics.
Methods: Plain and impregnated material, with and without plasma protein conditioning film, were exposed to Staphylococcus epidermidis. Bacterial adherence was determined by scanning electron microscopy, chemiluminescence and culture. Time taken to kill 100% of bacteria (tK100) was determined by serial chemiluminescence, culture and the use of differential viability microscopy.
Results: The antimicrobial material did not reduce bacterial adherence. However, 100% of attached bacteria were killed in 48–52 h, even in the presence of a conditioning film.
Conclusions: Impregnated antimicrobial material is likely to reduce shunt infection rates significantly without the risks and side effects of systemic antibiotics.
Keywords: hydrocephalus shunt infections, prevention, catheters
* Corresponding author. E-mail: roger.bayston{at}nottingham.ac.uk
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