Search Results (479)

Long-term clinical translation of left ventricular assist devices (LVADs) is severely hampered by thromboembolism and device-related infection, both originating from inadequate biocompatibility of the device-blood interface. Current titanium surface modifications fail to simultaneously deliver durable antithrombotic and antibacterial performance, while conventional polydopamine-copper (PDA-Cu) coatings suffer from inherent limitations. Herein, we report a one-step rapid co-polymerization strategy based on mussel-inspired polyphenol chemistry to fabricate a copper-integrated polydopamine/tannic acid nanocoating on titanium (Ti/PDT(Cu)). By incorporating tannic acid rich in catechol/pyrogallol moieties, we achieve synergistic acceleration of dopamine oxidative polymerization with copper ions, dramatically shortening the fabrication time to 8 h (vs. 24 h for traditional PDA coatings). This process simultaneously constructs a robust dual-crosslinked network through covalent/hydrogen bonds and metal-phenolic coordination, exhibiting a uniform nanoscale-roughened structure. Comprehensive physicochemical characterizations confirm homogeneous coating deposition, excellent hydrophilicity, uniform Cu distribution, and superior long-term structural stability (95.68% thickness retention after 7 days of physiological immersion). The optimized coating displays broad-spectrum and durable antibacterial activity, with 92.79% and 89.73% reduction of E. coli and S. aureus at 24 h, respectively, and retains $>$89% antibacterial efficacy after 7 days of continuous elution (n = 3, * p$<$ 0.05). Moreover, the coating enables stable and sustained catalytic nitric oxide generation (43.85 $\pm$ 2.36 μM cumulative release over 14 days) that mimics endothelial function, resulting in 69.4% inhibition of platelet adhesion and an ultralow hemolysis ratio of 0.97% (n = 3). Critically, it maintains excellent cytocompatibility with L929 fibroblasts ($>$90% cell viability after 72 h co-culture). This work addresses key limitations of conventional PDA-based functional coatings, realizes synergistic antithrombotic and antibacterial dual functions showing great potential for blood-contacting cardiovascular device applications, and provides a facile and robust surface engineering platform for long-term implantable cardiovascular devices. Full article

Serratia marcescens has emerged as an important opportunistic pathogen in intensive care units (ICUs), where critically ill patients, invasive devices, antimicrobial exposure, and complex environmental reservoirs create favorable conditions for colonization, infection, and recurrent outbreaks. This narrative review synthesizes evidence from the past decade regarding the clinical and molecular epidemiology, environmental persistence, device-associated transmission, biofilm-mediated resistance, and infection-control strategies of S. marcescens in ICU settings. The literature was reviewed using an integrative approach informed by Ferrari’s narrative review framework, with thematic synthesis across clinical, microbiological, environmental, and genomic domains. Recent evidence indicates that ICU-associated S. marcescens infections frequently involve respiratory tract colonization, ventilator-associated pneumonia, bloodstream infection, urinary tract infection, and device-related transmission. Hospital water systems, sink drains, wet surfaces, ventilator circuits, reusable equipment, and contaminated antiseptic or liquid products may serve as persistent reservoirs, particularly when biofilm formation supports long-term survival and recurrent dissemination. At the molecular level, S. marcescens demonstrates substantial genomic diversity, intrinsic and acquired antimicrobial resistance, inducible AmpC β-lactamase activity, efflux-mediated tolerance, and plasmid-associated resistance gene transfer. This review particularly emphasizes the molecular determinants that enable S. marcescens to persist in ICU ecosystems, including AmpC-mediated β-lactam resistance, efflux-associated tolerance, quorum-sensing-regulated biofilm formation, plasmid-mediated horizontal gene transfer, and WGS-defined clonal transmission. Whole-genome sequencing, rapid molecular diagnostics, active surveillance, environmental sampling, and integrated infection-control bundles have become increasingly important for distinguishing clonal outbreaks from endemic transmission and guiding timely interventions. Emerging perspectives emphasize the need to combine antimicrobial stewardship, environmental engineering, respiratory-care auditing, anti-biofilm strategies, and AI-assisted real-time surveillance into adaptive ICU infection-control frameworks. Overall, S. marcescens should be regarded not merely as an episodic outbreak organism, but as a highly adaptable ICU-associated pathogen requiring multidisciplinary prevention strategies. Full article

Mechanical circulatory support (MCS) has transformed the management of advanced heart failure; however, device-related morbidity remains substantially driven by adverse interactions occurring at the blood–material and tissue–device interfaces. Despite progressive miniaturization and the evolution from first-generation pulsatile systems to contemporary continuous-flow devices, thrombotic, hemorrhagic, infectious, and inflammatory complications continue to limit long-term outcomes. This review examines the mechanistic contribution of material properties, surface architecture, and hemodynamic conditions to the pathogenesis of major MCS-associated complications, with particular emphasis on thrombogenicity, biomaterial-induced inflammatory activation, driveline and cannulation-associated infections, hemocompatibility disturbances, and device-related structural failure. The interplay between protein adsorption, platelet activation, complement cascade dysregulation, disturbed shear profiles, and biofilm formation is analyzed as a central determinant of adverse clinical events. Special attention is given to pediatric MCS, in which the continued reliance on extracorporeal pulsatile systems, unique anatomical constraints, and narrow therapeutic margins intensify susceptibility to both thromboembolic and infectious sequelae. Furthermore, the review addresses how material and surface modifications, and emerging biomimetic and anti-thrombogenic coatings may influence complication mitigation. By integrating clinical, engineering, and biomaterials perspectives, this work highlights that many complications traditionally regarded as secondary clinical phenomena are fundamentally rooted in device–material interactions and flow-mediated biological responses. Improved understanding of these mechanisms is essential for optimizing device design, enhancing hemocompatibility, and reducing complication burden in both adult and pediatric MCS populations. Full article

Photodynamic therapy (PDT) represents a promising non-antibiotic strategy for addressing bacterial and fungal infections, particularly in the context of increasing antimicrobial resistance and biofilm-associated disease. PDT is based on the light-induced activation of photosensitizers, leading to the generation of reactive oxygen species (ROS), including singlet oxygen (¹O₂), which induce oxidative damage to multiple microbial targets. Unlike conventional antimicrobial drugs that often act through specific molecular pathways, antimicrobial PDT produces simultaneous damage to membranes, proteins, nucleic acids, and extracellular biofilm components, thereby reducing the probability of resistance development. This review critically analyzes the cellular, biochemical, and biophysical determinants that govern PDT selectivity toward bacterial and fungal cells in comparison with mammalian host tissues. Particular attention is given to photosensitizer localization, membrane interactions, photobleaching, oxygen dependence, light penetration, and the balance between Type I and Type II photochemical mechanisms. The review provides a comparative overview of major molecular photosensitizer classes, including phenothiazines, porphyrins, chlorins, phthalocyanines, xanthene dyes, natural polyphenols, endogenous compounds, and advanced targeted photosensitizers. In addition, this review distinguishes molecular photosensitizers from nanotechnology-based platforms and delivery systems. Nanoparticles, polymeric carriers, hydrogels, and light-activated coatings are discussed not only as photosensitizer delivery tools, but also as systems that modulate aggregation, improve localization, enhance biofilm penetration, and enable surface-confined ROS generation. ROS are capable of causing phototoxic effects wherever they are located. Unless selectively accumulated by target organisms, there can be systemic phototoxicity. Overall, PDT should be regarded as a modular antimicrobial platform in which photosensitizer chemistry, formulation, light delivery, oxygen availability, and infection biology must be co-optimized. Although further studies are required to address clinical translation, regulatory complexity, material safety, and standardized treatment protocols, PDT offers a scientifically robust and clinically relevant approach that may complement conventional antibacterial and antifungal therapies, especially in localized, biofilm-associated, and device-related infections. Full article

Background: Infections remain a major complication in patients with left ventricular assist devices (LVADs). Enterococcal infections are increasingly recognized and are therapeutically challenging because of antimicrobial tolerance, biofilm formation on prosthetic material, and the frequent impossibility of device removal. Objective and method: We report two clinical cases of Enterococcus faecalis LVAD infection and a PRISMA-based systematic review of cases published between 1996 and 2025 that were identified through PubMed/MEDLINE. Primary outcomes were clinical cure, relapse or recurrence, mortality, and device removal. Results were synthesized descriptively. Results: Seventeen cases were analyzed, including 15 previously reported cases and two new cases. E. faecalis accounted for 47% of infections, Enterococcus faecium for 29%, and Enterococcus spp. without species identification for 24%. Bacteremia was the most common presentation, occurring in 76%, whereas LVAD-associated endocarditis occurred in 18%. Driveline or pocket involvement was reported in 41%. Suppressive antimicrobial therapy (SAT) was used in 29%, often as a bridge to heart transplantation. Cultures from explanted LVAD components were positive in 47% of cases despite prolonged antimicrobial therapy. Recurrence or relapse and overall mortality each occurred in 18% of patients. Conclusions: Enterococcal LVAD infections may be associated with microbiological persistence despite prolonged therapy. SAT may help control infection in selected patients and bridge to heart transplantation when device removal is not feasible. Full article

Background: Chronic pain is the leading cause of years lived with disability worldwide, with low back pain representing the most prevalent and disabling condition. Spinal cord stimulation (SCS) and intrathecal drug delivery (IDD) systems are established neuromodulation techniques for refractory chronic pain. However, a subset of patients experiences partial or declining benefit with either modality alone. In such cases, combined therapy may represent a rescue strategy. Methods: retrospective case series at a single center, including patients previously implanted with SCS who subsequently required IDD due to loss of efficacy or inadequate pain coverage. Pain intensity, opioid consumption, health-related quality of life, and patient satisfaction were assessed using validated instruments. Results: Twelve patients were included. Persistent low back pain with mixed nociceptive–neuropathic features was the most common indication. Combined therapy was observed in association with a mean reduction of 3.5 points on the Numeric Rating Scale, corresponding to an approximate 40% decrease in pain intensity. More than half of the patients discontinued systemic opioids. Complications occurred in seven patients (58.3%), mostly hardware-related and manageable with surgical revision; only one patient developed a device-related infection. Conclusions: In this case series, combined SCS and IDD therapy was observed in association with clinically meaningful pain reduction, decreased opioid use, and high patient-reported satisfaction. Although quality-of-life scores remained below population norms, patients consistently reported subjective improvement. Combined neuromodulation may represent a valid rescue option in selected patients with insufficient response to SCS alone. Full article

Background/Objectives: Hospital-Acquired Infections (HAI) represent one of the most frequent adverse events during care delivery, with the pediatric population (0–18 years) presenting unique vulnerabilities due to their developing immune systems, dependence on caregivers, and need for invasive devices. Despite the availability of general guidelines, existing high-level evidence is largely extrapolated from adult studies, and pediatric settings differ significantly in patient physiology and equipment size. This scoping review aims to map the key concepts, types of evidence, and research gaps related to strategies preventing HAI in pediatric patients. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The Population, Concept, and Context (PCC) framework will be utilized. We will include any strategy, intervention, or protocol aimed at preventing HAI. A comprehensive search will be conducted across ten major electronic databases and grey literature sources. Two independent reviewers will screen titles, abstracts, and full texts, followed by data extraction using a standardized tool to categorize the interventions and key findings. Results: The findings will synthesize diverse practices into a usable format for clinical decision-makers and identify gaps where primary pediatric research is lacking. This consolidated data aims to guide resource allocation and assist hospital infection control committees in updating pediatric safety protocols. Conclusions: This scoping review will establish a comprehensive baseline of pediatric-specific HAI prevention strategies. The findings will inform evidence-based practice, identify critical research gaps, and guide future investigations in the prevention of pediatric infections in healthcare settings. Full article

Serratia spp., particularly Serratia marcescens, have emerged as clinically important opportunistic pathogens and are increasingly recognized as causes of healthcare-associated infections, especially among critically ill and immunocompromised patients. Their remarkable ecological adaptability, persistence in hospital environments, and capacity to acquire multiple antimicrobial resistance determinants have contributed to the global emergence of multidrug-resistant strains and complicated therapeutic management. This review aims to comprehensively analyze the epidemiology, virulence mechanisms, antimicrobial resistance patterns, and current and emerging therapeutic strategies associated with Serratia spp. The manuscript is based on a critical review and analysis of previously published literature retrieved from electronic scientific databases focusing on clinically relevant Serratia spp. infections and resistance trends. The reviewed literature demonstrates that Serratia spp. combine intrinsic resistance mechanisms, particularly inducible chromosomal AmpC β-lactamases, with acquired resistance determinants including extended-spectrum β-lactamases, carbapenemases, aminoglycoside-modifying enzymes, and plasmid-mediated quinolone resistance. Horizontal gene transfer and biofilm formation further enhance bacterial persistence, dissemination, and adaptation within healthcare settings. Clinically, these pathogens are associated with device-related infections, bloodstream infections, pneumonia, urinary tract infections, and hospital outbreaks, where increasing multidrug and carbapenem resistance significantly limits therapeutic options. Novel β-lactam/β-lactamase inhibitor combinations and cefiderocol represent promising therapeutic approaches, although treatment success remains highly dependent on accurate identification of underlying resistance mechanisms. This review highlights the growing public health importance of Serratia spp. and underscores the need for improved surveillance, molecular diagnostics, antimicrobial stewardship, and the development of innovative therapeutic strategies in the context of the evolving antimicrobial resistance crisis. Full article

Reducing hospital-acquired infections, especially those related to medical devices, is essential not only to improve patients’ well-being but also to reduce healthcare costs. Among various antibacterial approaches, creating bactericidal device surfaces has been advocated as it reduces the likelihood of antibiotic-resistant strains emerging when antibiotics are used. Functionalizing the device surface with cationic groups, such as quaternary ammonium terminal groups, has been considered an effective approach for killing microbes upon contact. Nonetheless, multiple steps, some of which may require harsh chemical reactions and toxic solvents, are generally required to attach the cationic quaternary ammonium functionalities to the surface. Inspired by the mussel’s capability to bind to various substrates, various novel biomimetic cationic catechol-terminated small molecules having the quaternary ammonium functionality with different alkyl chain lengths were synthesized for the first time. These compounds were used for surface modification of medical-grade titanium using simple immersion approaches: a single-layer procedure or a two-layer approach, in which the first layer was prepared by dopamine immersion, followed by a second immersion in the compound of interest. The surface characteristics and antimicrobial capability against the Gram-negative E. coli and Gram-positive S. aureus were assessed. The likely effects of the alkyl chain length and modification schemes on the surface properties and antibacterial activity are discussed and compared. The highest antimicrobial activity against E. coli was noted on the modified surfaces prepared by the two-layer approach with the cationic compound having the shortest alkyl chain, C1, at 2 mg/mL (DA_C1-2) and 8 mg/mL (DA_C1-8). The DA_C1-8 surface also exhibited the highest antimicrobial activity against S. aureus. These findings indicated that the antibacterial activity of titanium can be greatly improved by selecting the appropriate compound and a proper, facile immersion procedure. Full article

Background and Clinical Significance: Infective endocarditis is a disease of the endocardial surface of the heart, most often affecting heart valves (native or prosthetic) or intracardiac device. Although relatively rare, it carries high embolic risk of complications and mortality. Complete device extraction is recommended; however, conventional surgery may be prohibitive in frail patients with multiple comorbidities. Case presentation: We present a case of a 74-year-old male with implantable cardioverter-defibrillator (ICD)-related infective endocarditis and large lead-associated vegetation measuring approximately 3 cm in size. Due to a high operative risk assessed by Euro SCORE II, a minimally invasive percutaneous approach using the Penumbra vacuum-assisted aspiration system was selected. The procedure enabled successful debulking of the vegetation, followed by complete device removal and targeted antibiotic therapy. The patient’s clinical condition improved, with normalization of inflammatory markers and no recurrence of infection, and a new ICD was safely reimplanted after recovery. Conclusions: This case highlights the potential role of percutaneous vacuum-assisted aspiration as an effective and less invasive therapeutic option in high-risk patients with CIED-related infective endocarditis, particularly when conventional surgical management is contraindicated or requires bridging therapy until the patient’s status is stabilized. Full article

Emerging optical technologies may offer new opportunities for the non-invasive assessment of diabetic foot ulcers (DFUs), but the role of artificial intelligence (AI)-assisted autofluorescence-based approaches remains unclear. This scoping review aimed to map and summarise the published evidence on AI-assisted analysis of autofluorescence/fluorescence-based signals for DFU assessment and management. We searched Scopus, Web of Science, Embase, PubMed, CINAHL, Google Scholar, and the SPIE Digital Library, and also considered conference proceedings. We included English-language studies published between 2010 and October 2025. Of 197 records identified through database searching, 22 full-text articles were assessed for eligibility, and 5 studies met the inclusion criteria. Four studies focused on infection-related applications, specifically bacterial burden detection and Gram-type classification, whereas one study investigated tissue oxygenation estimation using a related optical imaging approach. All included studies were published between 2022 and 2025, were conducted in India, and four of the five evaluated the same device family or related variants. Overall, the evidence base was limited, geographically restricted, and technologically narrow. In addition, reporting of participant characteristics and AI methodology was often incomplete, with several studies relying on embedded proprietary or insufficiently described algorithmic components. Taken together, the available literature supports early proof-of-feasibility in restricted and largely device-specific evaluation settings rather than robust evidence of broad clinical validity, implementation readiness, or routine-care utility. Larger, more diverse, and independently validated studies with standardised acquisition procedures and more transparent AI reporting are needed before these approaches can be meaningfully evaluated for routine DFU care. Full article

Background: Spasticity is a major contributor to pain, impaired mobility, contractures, and caregiver burden in children with cerebral palsy. Intrathecal baclofen (ITB) is an established treatment for severe generalized spasticity when rehabilitation, oral medications, and focal interventions are insufficient or poorly tolerated. Methods: This critical review synthesizes current evidence on ITB in children with cerebral palsy, focusing on patient selection, screening, rehabilitation goals, functional outcomes, complications, and long-term management. Results: Available evidence consistently demonstrates substantial and sustained tone reduction with ITB, with associated improvements in comfort, positioning, ease of care, pain, and selected quality-of-life domains. However, gains in gross motor function are variable and depend on baseline motor phenotype, individualized treatment goals, and careful dose titration. Device-related complications, infections, catheter dysfunction, overdose, and withdrawal remain clinically significant risks requiring specialized multidisciplinary follow-up. Compared with selective dorsal rhizotomy and botulinum toxin injections, ITB provides a reversible and programmable option particularly suited to children with severe, generalized spasticity and high caregiving needs. Conclusions: ITB represents an important component of comprehensive, goal-directed spasticity management in appropriately selected children. Further high-quality longitudinal and comparative studies are needed to define long-term functional and cost-effectiveness outcomes better. Full article

Breast implants are among the most frequently used long-term implantable medical devices in aesthetic and reconstructive surgery. In addition to correcting anatomical deficits, they have significant psychosocial effects, influencing body image, self-esteem, and quality of life, particularly in patients undergoing postmastectomy reconstruction. This review provides a comprehensive overview of the historical development, biological interactions, material characteristics, and clinical outcomes of breast implants. Early reconstructive attempts using foreign materials and injectable substances were associated with severe complications, underscoring the need for safer technologies. The introduction of silicone gel implants in the 1960s marked a pivotal advancement, followed by the development of saline-filled devices and highly cohesive silicone gels with enhanced mechanical stability. Key surgical considerations, including incision type and implant placement plane (subglandular, submuscular, dual-plane, and subfascial), are discussed in relation to aesthetic outcomes and complication risk. Emphasis is placed on the implant–tissue interface and the foreign body response (FBR), a process involving protein adsorption, immune cell activation, fibrous capsule formation, and potential chronic inflammation. Persistent inflammatory stimulation, often associated with bacterial biofilm formation, contributes to capsular contracture, the most common long-term complication. Additional adverse events include implant rupture, silicone gel bleed, granulomatous reactions, infection, hematoma, implant malposition, and rare but clinically significant conditions such as breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The review also summarizes implant classification according to construction, filling material, shape, and surface topography, highlighting the influence of surface characteristics on host response and clinical outcomes. Advances in biomaterials, cohesive gel formulations, and surface engineering aim to enhance biocompatibility and long-term safety, supported by standardized mechanical and biological testing protocols. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before–after, controlled before–after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies. Full article