Anti-infective efficacy of silver-coated medical prostheses.

Medical prostheses constitute an indispensable component of modern health care. Like other approaches of medical intervention, the insertion of medical prostheses can be associated with serious complications. The ongoing advances in the mechanical properties of medical prostheses have not necessarily resulted in lower rates of prosthesis-related infection. Infection remains the most common serious complication of medical prostheses. For instance, vascular catheters account for most cases of nosocomial bloodstream infection [1], and catheterrelated urinary tract infection is the most frequent nosocomial infection [2]. Two decades ago, infections associated with medical prostheses accounted for about half of all nosocomial infections [2]. Today, with their increasing use, medical prostheses are expected to cause a larger portion of cases of nosocomial infections, particularly in the subpopulations of immunocompromised, chronically ill, and elderly subjects. Infections associated with medical prostheses result in major morbidity and can be life-threatening. For instance, the mortality associated with prosthetic valve endocarditis ranges from 30% to 80% in patients with early-onset infection and from 20% to 40% in patients with late-onset endocarditis [3]. Often, infections associated with medical prostheses are very expensive to manage, and their cure requires removal of the infected prosthesis. For example, findings from the Dutch Trauma Trial indicated a mean cost of $22,000 (in 1991 dollars) to treat a patient who developed a deep wound infection after internal fixation of a closed fracture [4].