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Healthcare-associated infections from indwelling medical devices are common and difficult to diagnose. This review conceptualizes device infection pathogenesis, focusing on biofilms and host responses to guide prevention and treatment strategies.

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Area of Science:

  • Biomedical Engineering
  • Infectious Diseases
  • Materials Science

Background:

  • Healthcare-associated infections (HAIs) are a significant burden, with over half linked to indwelling medical devices.
  • Diagnosing implantable device-related infections is challenging, potentially leading to underestimation of their prevalence.
  • Understanding device infection pathogenesis is crucial for developing effective countermeasures.

Purpose of the Study:

  • To provide a length-scale conceptualization of device-related infection pathogenesis.
  • To review current and developing preventative strategies targeting specific processes in device infections.
  • To highlight the need for parallel development of in situ treatment strategies for device infections.

Main Methods:

  • Literature review focusing on biofilm formation, host immune, and coagulation systems.
  • Development of a length-scale conceptualization framework for device infection pathogenesis.
  • Analysis of existing and emerging preventative and treatment strategies within the conceptual framework.

Main Results:

  • Device-related infections are complex, involving biofilm formation and host-pathogen interactions.
  • Current preventative strategies target various stages of infection along the length-scale.
  • A significant time lag exists for developing and translating new preventative technologies.

Conclusions:

  • A length-scale conceptualization aids in understanding and addressing device-related infections.
  • Both preventative and in situ treatment strategies are essential for managing these infections.
  • Future research should focus on integrated approaches combining prevention and treatment informed by the conceptual framework.