Anti-infective catheters: Novel strategies to prevent nosocomial infections in oncology

Intravenous access contributes significantly to the therapeutical success a nd to the comfort of oncologic patients. The highest risk for bloodstream i nfections, however, is vascular catheter-mediated. In oncology high mortali ty is associated with Pseudomonas aeruginosa, Candida albicans and Staphylo coccus aureus sepsis. Besides established hygienic measures, the coupling o r incorporation of antimicrobial substances to or into catheter materials m ay be a suitable way to prevent the development of catheter-associated infe ctions. Here we present a risk- benefit evaluation of different models of a ntimicrobial catheter coated with silver, antiseptics or antibiotics. The c ontroversial reports on clinical efficacy and the potential of adverse reac tions due to silver and antiseptic coated catheters are discussed. The micr obiological, pharmaceutical and physicochemical backgrounds of different ty pes of coating are discussed in detail. Incorporation of antimicrobial agen ts into long-term silicon catheters providing a slow release of those subst ances through the external and internal surfaces of catheters may be the mo st effective technological innovation for reducing biomaterial-mediated nos ocomial infections.