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Estratégias de prevenção de infeções associadas a cateteres
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Numa época em que as infeções adquiridas em ambiente hospitalar atingem números altos existe a necessidade de encontrar soluções que visem a sua prevenção. Assim sendo, é de interesse comum minimizar os tipos de infeção mais frequentes nestes meios, entre as quais, infeções associadas à utilização de cateteres vasculares e urinários.
A prevenção destes tipos de infeções começa ainda antes da inserção dos dispositivos médicos pela esterilização destes e pela desinfeção das mãos dos prestadores de cuidados saúde que o irão inserir, passando pelos cuidados na manutenção. Além desses cuidados, as infeções adquiridas pela utilização de dispositivos médicos podem ser prevenidas pela utilização de cateteres constituídos por materiais e moléculas que evitem a formação de biofilmes e consequentemente infeções.
Dessa forma, este trabalho tem como objetivo enunciar os materiais e agentes antimicrobianos de revestimento já usados e as inovações na prevenção de infeções vasculares e urinárias associadas a cateteres.
Como estratégias de prevenção de contaminação antimicrobiana podem ser utilizados diferentes materiais para a conceção do cateter e também revestimentos com propriedades antisséticas/bactericidas ou antiadesivas. Dentro das estratégias mais estudadas encontram-se os revestimentos com propriedades antimicrobianas. Entre estes é possível destacar a utilização de metais antibacterianos (e.g. prata), compostos orgânicos (e.g. compostos de amónio quaternário, quitosano e ácido salicílico) e inorgânicos (e.g. espécies reativas de azoto), antibióticos (e.g. a ciprofloxacina, a vancomicina, a gentomicina, a daptomicina, a rifampicina e a minociclina), péptidos antimicrobianos e enzimas.
O revestimento com antibióticos continua sem duvida a ser a forma mais eficaz de prevenir infeções associadas a cateteres, contudo, estes estão em desuso por provocarem resistências bacterianas.
Os cateteres revestidos com enzimas e com moléculas inibidoras de quórum sensing descritas no final da monografia são as estratégias mais recentes no que concerne à prevenção de infeções. São moléculas inspiradas noutras existentes no sistema imunitário, apresentando por isso elevada biocompatibilidade e especificidade.
Assim, o futuro do revestimento de cateteres consiste em sintetizar moléculas biocompatíveis, seletivas para os microrganismos patogénicos com um elevado espetro de ação.
Nowadays the infections acquired in the hospital reach high numbers, there is necessary to find solutions aimed at preventing them. Therefore, it is common interest to minimize the most frequent types of hospital infections, infections associated with the use of vascular and urinary catheters. The prevention of these types of infections begins even before the insertion of the medical device by the sterilization of the devices and by disinfecting the hands of healthcare providers who will insert that, is also important to be very careful at the maintenance of the device and at the removal time. The infections associated with the use of catheter may be prevented by the use of catheters made by materials and molecules which can prevent biofilm formation and consequently the infection process. Thus, this study aims to describe the materials and antimicrobial coating agents already used in the prevention of vascular and urinary infections associated with catheters, but also on the innovations in this area. As antimicrobial contamination prevention strategies it can be used various materials for the design of the catheter and also coatings with antiseptic / bactericide or anti-adhesive properties. Among the most studied strategies there are coatings with antimicrobial properties. Among these it is possible to highlight the use of antibacterial metals (e.g silver), inorganic (e.g. reactive species of nitrogen) and organic (e.g. quaternary ammonium compounds, chitosan and salicylic acid) compounds, antibiotics (e.g. ciprofloxacin, vancomycin, gentamicin, daptomycin, rifampicin and minocycline), antimicrobial peptides and enzymes. The coating with antibiotics continues without doubt to be the most effective way to prevent infections associated with catheters, however, these are disused by causing bacterial resistance. Catheters coated with enzymes and quorum sensing inhibitors molecules described at the end of the monograph are the most recent strategies in the prevention of infections. They are inspired on molecules that exist in the animal immune system, with high biocompatibility and specificity. Thus, the future of the catheter coating is to synthesize biocompatible molecules selective for pathogenic microorganisms with a higher spectrum of action.
Nowadays the infections acquired in the hospital reach high numbers, there is necessary to find solutions aimed at preventing them. Therefore, it is common interest to minimize the most frequent types of hospital infections, infections associated with the use of vascular and urinary catheters. The prevention of these types of infections begins even before the insertion of the medical device by the sterilization of the devices and by disinfecting the hands of healthcare providers who will insert that, is also important to be very careful at the maintenance of the device and at the removal time. The infections associated with the use of catheter may be prevented by the use of catheters made by materials and molecules which can prevent biofilm formation and consequently the infection process. Thus, this study aims to describe the materials and antimicrobial coating agents already used in the prevention of vascular and urinary infections associated with catheters, but also on the innovations in this area. As antimicrobial contamination prevention strategies it can be used various materials for the design of the catheter and also coatings with antiseptic / bactericide or anti-adhesive properties. Among the most studied strategies there are coatings with antimicrobial properties. Among these it is possible to highlight the use of antibacterial metals (e.g silver), inorganic (e.g. reactive species of nitrogen) and organic (e.g. quaternary ammonium compounds, chitosan and salicylic acid) compounds, antibiotics (e.g. ciprofloxacin, vancomycin, gentamicin, daptomycin, rifampicin and minocycline), antimicrobial peptides and enzymes. The coating with antibiotics continues without doubt to be the most effective way to prevent infections associated with catheters, however, these are disused by causing bacterial resistance. Catheters coated with enzymes and quorum sensing inhibitors molecules described at the end of the monograph are the most recent strategies in the prevention of infections. They are inspired on molecules that exist in the animal immune system, with high biocompatibility and specificity. Thus, the future of the catheter coating is to synthesize biocompatible molecules selective for pathogenic microorganisms with a higher spectrum of action.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2016
Palavras-chave
Prevenção Infeção Agentes antimicrobianos Cateter urinário Cateter vascular Mestrado Integrado - 2016