JAC Advance Access published online on March 31, 2004
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkh183
© 2004 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Biomaterials-Related Infection Group, Division of Orthopaedic
and Accident Surgery, C Floor West Block, University Hospital, Nottingham
NG7 2UH, UK
* Corresponding author. E-mail: roger.bayston{at}nottingham.ac.uk.
Received 15 August 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
Mode of action of an antimicrobial biomaterial
for use in hydrocephalus shunts
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