Physical Medicine & Rehabilitation
The bionic man: prevention of infections of software and hardware
Infection is the most common serious complication of indwelling medical prostheses. Management of prosthesis-related infections remains problematic as it often requires removal of the infected prosthesis to establish cure and can be very expensive. Although a large number of strategies have been proposed to be preventive, only few have been demonstrated to clinically protect against prosthesis-related infections. Because bacterial colonization of the surface of the prosthesis is a prerequisite for the occurrence of prosthesis-related infection, Dr. Darouiche and his laboratory developed novel approaches to render a variety of medical prostheses anti-infective by coating them with effective antimicrobial agents. Their ability to transfer new technology from the bench-side to the bed‑side was best exemplified by their series of in vitro, animal and clinical studies demonstrating that central venous catheters coated with minocycline and rifampin significantly protect against catheter-related infections, as compared with either uncoated catheters or another preexisting type of antimicrobial-coated catheters. They utilized various coating technologies to render other types of medical prostheses anti‑infective, including bladder catheters (completed clinical trial), ventricular catheters (clinical trial in progress), nephrostomy catheters (embarking on a clinical trial), prosthetic heart valve sewing cuffs (embarking on a clinical trial), left ventricular assist devices (preclinical studies), penile implants (preclinical studies), vascular grafts (preclinical studies), breast implants (preclinical studies), and fracture fixation devices (preclinical studies). The use of anti‑infective medical prostheses that can improve patient care and decrease the cost of health care is likely to become the standard of care in patients at high risk of infection.
Dr. Darouiche’s nomination was based on the following publications:
Darouiche RO, Farmer J, Chaput C, Mansouri M, Saleh G, Landon GC Anti-infective efficacy of antiseptic-coated intramedullary nails. J Bone Joint Surg Am. 1998 Sep;80(9):1336-40.
Darouiche RO, Meade R, Mansouri M, Raad II. In vivo efficacy of antimicrobial-coated fabric from prosthetic heart valve sewing rings. J Heart Valve Dis. 1998 Nov;7(6):639-46.
Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, Berg J, Khardori N, Hanna H, Hachem R, Harris RL, Mayhall G. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med. 1999 Jan 7;340(1):1-8.
Hull RA, Rudy DC, Donovan WH, Wieser IE, Stewart C, Darouiche RO. Virulence properties of Escherichia coli 83972, a prototype strain associated with asymptomatic bacteriuria. Infect Immun. 1999 Jan;67(1):429-32.