Infections related to implanted medical devices have become a significant health care issue in recent decades. Increasing numbers of medical devices are in use, often in an aging population, and these devices are implanted into a background of increasingly prevalent antibiotic-resistant bacteria in the hospital and community setting. Progressively more challenging clinical presentations, requiring ever more refined treatment options are predicted to emerge with greater frequency in the coming decades. Improvements in the prevention, diagnosis and treatment of these device-associated infections will become increasingly important both for clinicians and the translational research community charged with addressing these challenges. Preclinical research focused on improved antimicrobial interventions face numerous technical and translational hurdles in successfully delivering relevant infection models and informative experimental designs that guide novel therapies with real clinical impact. Preclinical strategies predictive of ultimate clinical efficacy serve as a control point for effective translation of new technologies to clinical applications. Effective translation of a research idea to a clinically available product requires preclinical (in vitro and in vivo) as well as clinical data. Reliable validation of experimental and preclinical antimicrobial methodologies currently suffers from a variety of technical limitations: little agreement on experimental protocols; inadequate standardisation of experimental procedures; general lack of correlation between in vitro and in vivo preclinical results; and lack of validation between in vivo preclinical implant infection models and clinical (human) results. The development of new anti-infective medical devices requires a validated preclinical testing protocol. Device-associated infections also present numerous technical challenges to the clinical laboratory. In particular, reliable diagnosis of infection, rapid, reliable culture and identification of pathogens in biofilm infections. Antibiotic agent selection is also complicated in biofilm infections due to lack of correlation between in vitro antibiotic susceptibility testing and treatment success.
The Grainger group seeks to address these critical challenges facing both preclinical research and clinical laboratories in improving the diagnosis and treatment of medical device-associated infections. Focus on antimicrobial biomaterials, local delivery from medical devices and characterization of the implant-tissue microenvironment are current objectives.