Biomodification Strategies for the Development of Antimicrobial Urinary Catheters: Overview and Advances

Surface Immobilization of Oxidized Carboxymethyl Cellulose on Polyurethane for Sustained Drug Delivery

Polyurethane (PU) has a diverse array of customized physical, chemical, mechanical, and structural characteristics, rendering it a superb option for biomedical applications. The current study involves modifying the polyurethane surface by the process of aminolysis (aminolyzed polyurethane; PU-A), followed by covalently immobilizing Carboxymethyl cellulose (CMC) polymer utilizing Schiff base chemistry. Oxidation of CMC periodically leads to the creation of dialdehyde groups along the CMC chain. When the aldehyde groups on the OCMC contact the amine group on a modified PU surface, they form an imine bond. Scanning electron microscopy (SEM), contact angle, and X-ray photoelectron spectroscopy (XPS) techniques are employed to analyze and confirm the immobilization of OCMC on aminolyzed PU film (PU-O). The OCMC gel incorporates Nitrofurantoin (NF) and immobilizes it on the PU surface (PU-ON), creating an antibacterial PU surface. The confirmation of medication incorporation is achieved using EDX analysis. The varying doses of NF have demonstrated concentration-dependent bacteriostatic and bactericidal effects on both Gram-positive and Gram-negative bacteria, in addition to sustained release. The proposed polyurethane (PU-ON) surface exhibited excellent infection resistance in in vivo testing. The material exhibited biocompatibility and is well-suited for biomedical applications.

Long-Lasting Antibacterial PDMS Surfaces Constructed from Photocuring of End-Functionalized Polymers

A challenge remains in the development of anti-infectious coatings for the inert surfaces of biomedical devices that are prone to bacterial colonization and biofilm formation. Here, a facile photocuring method to construct functionalized polymeric coatings on inert polydimethylsiloxane (PDMS) surfaces, is developed. Using atom transfer radical polymerization (ATRP) initiator bearing thymol group, hydrophilic DMAEMA and benzophenone (BP)-containing monomers are copolymerized to form polymers with end functional groups. An end-functionalized biocidal coating is then constructed on the inert PDMS surface in one step using a photocuring reaction. The functionalized PDMS surfaces show excellent antibacterial and antifouling properties, are capable of completely eradiating MRSA within ≈6 h, and effectively inhibit the growth of biofilms. In addition, they have good stability and long-lasting antibacterial activity in body fluid environments such as 0.9% saline and urine. According to bladder model experiments, the catheter's lifespan can be extended from ≈7 to 35 days by inhibiting the growth and migration of bacteria along its inner surface. The photocuring technique is therefore very promising in terms of surface functionalization of inert biomedical devices in order to minimize the spread of infection.

Dual-Layer Nanoengineered Urinary Catheters for Enhanced Antimicrobial Efficacy and Reduced Cytotoxicity

Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection; however, current therapeutic strategies remain insufficient for standard clinical application. A novel urinary catheter featuring a dual-layer nanoengineering approach using zinc (Zn) and silver nanoparticles (AgNPs) is successfully fabricated. This design targets microbial resistance, minimizes cytotoxicity, and maintains long-term efficacy. The inner AgNPs layer provides immediate antibacterial effects against the UTI pathogens, while the outer porous Zn layer controls zero-order Ag release and generates reactive oxygen species, thus enhancing long-term bactericidal performance. Enhanced antibacterial properties of Zn/AgNPs-coated catheters are observed, resulting in 99.9% of E. coli and 99.7% of S. aureus reduction, respectively. The Zn/AgNPs-coated catheter significantly suppresses biofilm with sludge formation compared to AgNP-coated and uncoated catheters (all, p < 0.05). The Zn/AgNP-coated catheter in a rabbit model demonstrated a durable, effective barrier against bacterial colonization, maintaining antimicrobial properties during the catheter indwelling period with significantly reduced inflammation and epithelial disruption compared with AgNP and uncoated groups. This innovation has the potential to revolutionize the design of antimicrobial medical devices, particularly for applications requiring long-term implantation. Although further preclinical studies are required to verify its efficacy and safety, this strategy seems to be a promising approach to preventing CAUTI-related complications.

Long-term antifouling surfaces for urinary catheters

The presence of a variety of bacteria is an inevitable/indispensable part of human life. In particular, for patients, the existence and spreading of bacteria lead to prolonged treatment period with many more complications. The widespread use of urinary catheters is one of the main causes for the prevalence of infections. The necessity of long-term use of indwelling catheters is unavoidable in terms of the development of bacteriuria and blockage. As is known, since a permanent solution to this problem has not yet been found, research and development activities continue actively. Herein, polyethylene glycol (PEG)-like thin films were synthesized by a custom designed plasma enhanced chemical vapor deposition (PE-CVD) method and the long-term effect of antifouling properties of PEG-like coated catheters was investigated against Escherichia coli and Proteus mirabilis. The contact angle measurements have revealed the increase of wettability with the increase of plasma exposure time. The antifouling activity of surface-coated catheters was analyzed against the Gram-negative/positive bacteria over a long-term period (up to 30 days). The results revealed that PE-CVD coated PEG-like thin films are highly capable of eliminating bacterial attachment on surfaces with relatively reduced protein attachment without having any toxic effect. Previous statements were supported with SEM, XPS, FTIR spectroscopy, and contact angle analysis.

Dual-function antimicrobial-antibiofilm peptide hybrid to tackle biofilm-forming Staphylococcus epidermidis

BACKGROUND

Due to their resistance and difficulty in treatment, biofilm-associated infections are problematic among hospitalized patients globally and account for 60% of all bacterial infections in humans. Antibiofilm peptides have recently emerged as an alternative treatment since they can be effectively designed and exert a different mode of biofilm inhibition and eradication.

METHODS

A novel antibiofilm peptide, BiF, was designed from the conserved sequence of 18 α-helical antibiofilm peptides by template-assisted technique and its activity was improved by hybridization with a lipid binding motif (KILRR). Novel antibiofilm peptide derivatives were modified by substituting hydrophobic amino acids at positions 5 or 7, and both, with positively charged lysines (L5K, L7K). These peptide derivatives were tested for antibiofilm and antimicrobial activities against biofilm-forming Staphylococcus epidermidis and multiple other microbes using crystal violet and broth microdilution assays, respectively. To assess their impact on mammalian cells, the toxicity of peptides was determined through hemolysis and cytotoxicity assays. The stability of candidate peptide, BiF2_5K7K, was assessed in human serum and its secondary structure in bacterial membrane-like environments was analyzed using circular dichroism. The action of BiF2_5K7K on planktonic S. epidermidis and its effect on biofilm cell viability were assessed via viable counting assays. Its biofilm inhibition mechanism was investigated through confocal laser scanning microscopy and transcription analysis. Additionally, its ability to eradicate mature biofilms was examined using colony counting. Finally, a preliminary evaluation involved coating a catheter with BiF2_5K7K to assess its preventive efficacy against S. epidermidis biofilm formation on the catheter and its surrounding area.

RESULTS

BiF2_5K7K, the modified antibiofilm peptide, exhibited dose-dependent antibiofilm activity against S. epidermidis. It inhibited biofilm formation at subinhibitory concentrations by altering S. epidermidis extracellular polysaccharide production and quorum-sensing gene expression. Additionally, it exhibited broad-spectrum antimicrobial activity and no significant hemolysis or toxicity against mammalian cell lines was observed. Its activity is retained when exposed to human serum. In bacterial membrane-like environments, this peptide formed an α-helix amphipathic structure. Within 4 h, a reduction in the number of S. epidermidis colonies was observed, demonstrating the fast action of this peptide. As a preliminary test, a BiF2_5K7K-coated catheter was able to prevent the development of S. epidermidis biofilm both on the catheter surface and in its surrounding area.

CONCLUSIONS

Due to the safety and effectiveness of BiF2_5K7K, we suggest that this peptide be further developed to combat biofilm infections, particularly those of biofilm-forming S. epidermidis.

Medical Device-Associated Biofilm Infections and Multidrug-Resistant Pathogens

Medical devices such as venous catheters (VCs) and urinary catheters (UCs) are widely used in the hospital setting. However, the implantation of these devices is often accompanied by complications. About 60 to 70% of nosocomial infections (NIs) are linked to biofilms. The main complication is the ability of microorganisms to adhere to surfaces and form biofilms which protect them and help them to persist in the host. Indeed, by crossing the skin barrier, the insertion of VC inevitably allows skin flora or accidental environmental contaminants to access the underlying tissues and cause fatal complications like bloodstream infections (BSIs). In fact, 80,000 central venous catheters-BSIs (CVC-BSIs)-mainly occur in intensive care units (ICUs) with a death rate of 12 to 25%. Similarly, catheter-associated urinary tract infections (CA-UTIs) are the most commonlyhospital-acquired infections (HAIs) worldwide.These infections represent up to 40% of NIs.In this review, we present a summary of biofilm formation steps. We provide an overview of two main and important infections in clinical settings linked to medical devices, namely the catheter-asociated bloodstream infections (CA-BSIs) and catheter-associated urinary tract infections (CA-UTIs), and highlight also the most multidrug resistant bacteria implicated in these infections. Furthermore, we draw attention toseveral useful prevention strategies, and advanced antimicrobial and antifouling approaches developed to reduce bacterial colonization on catheter surfaces and the incidence of the catheter-related infections.

A comprehensive status update on modification of foley catheter to combat catheter-associated urinary tract infections and microbial biofilms

Present-day healthcare employs several types of invasive devices, including urinary catheters, to improve medical wellness, the clinical outcome of disease, and the quality of patient life. Among urinary catheters, the Foley catheter is most commonly used in patients for bladder drainage and collection of urine. Although such devices are very useful for patients who cannot empty their bladder for various reasons, they also expose patients to catheter-associated urinary tract infections (CAUTIs). Catheter provides an ideal surface for bacterial colonization and biofilm formation, resulting in persistent bacterial infection and severe complications. Hence, rigorous efforts have been made to develop catheters that harbour antimicrobial and anti-fouling properties to resist colonization by bacterial pathogens. In this regard, catheter modification by surface functionalization, impregnation, blending, or coating with antibiotics, bioactive compounds, and nanoformulations have proved to be effective in controlling biofilm formation. This review attempts to illustrate the complications associated with indwelling Foley catheters, primarily focussing on challenges in fighting CAUTI, catheter colonization, and biofilm formation. In this review, we also collate scientific literature on catheter modification using antibiotics, plant bioactive components, bacteriophages, nanoparticles, and studies demonstrating their efficacy through in vitro and in vivo testing.

Bioinspired bi-phasic 3D nanoflowers of MgO/Mg(OH)2 coated melamine sponge as a novel bactericidal agent

By roughly mimicking the surface architectural design of dragonfly wings, novel bi-phasic 3D nanoflowers of MgO/Mg(OH)2 were successfully synthesized via the electrospinning technique. The 3D nanoflowers were coated over a commercial melamine sponge and extensively characterized by SEM, XRD, FTIR, and EDS. The formation of distinct dense 3D nano petals was revealed by SEM images whereby the mean petal thickness and mean distance between the adjacent petals were found to be 36 nm and 121 nm, respectively. The bactericidal activities of synthesized 3D nano-flowers coated melamine sponges were assessed against five different bacteria (Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). This study demonstrated significant bactericidal activity of MgO/Mg(OH)2 3D nanoflowers coated MS against Gram-positive and Gram-negative bacteria. Plausible bactericidal mechanisms include envelope deformation, penetration, and induction of oxidative stress. This study introduces novel bioinspired biomaterial with the capacity to reduce the risk associated with pathogenic bacterial infections, especially in medical devices.

Emerging evidence-based innovative approaches to control catheter-associated urinary tract infection: a review

Healthcare settings have dramatically advanced the latest medical devices, such as urinary catheters (UC) for infection, prevention, and control (IPC). The continuous or intermittent flow of a warm and conducive (urine) medium in the medical device, the urinary catheter, promotes the formation of biofilms and encrustations, thereby leading to the incidence of CAUTI. Additionally, the absence of an innate immune host response in and around the lumen of the catheter reduces microbial phagocytosis and drug action. Hence, the review comprehensively overviews the challenges posed by CAUTI and associated risks in patients' morbidity and mortality. Also, detailed, up-to-date information on the various strategies that blended/tailored the surface properties of UC to have anti-fouling, biocidal, and anti-adhesive properties to provide an outlook on how they can be better managed with futuristic solutions.

Deposition of Chitosan on Plasma-Treated Polymers-A Review

Materials for biomedical applications often need to be coated to enhance their performance, such as their biocompatibility, antibacterial, antioxidant, and anti-inflammatory properties, or to assist the regeneration process and influence cell adhesion. Among naturally available substances, chitosan meets the above criteria. Most synthetic polymer materials do not enable the immobilization of the chitosan film. Therefore, their surface should be altered to ensure the interaction between the surface functional groups and the amino or hydroxyl groups in the chitosan chain. Plasma treatment can provide an effective solution to this problem. This work aims to review plasma methods for surface modification of polymers for improved chitosan immobilization. The obtained surface finish is explained in view of the different mechanisms involved in treating polymers with reactive plasma species. The reviewed literature showed that researchers usually use two different approaches: direct immobilization of chitosan on the plasma-treated surface or indirect immobilization by additional chemistry and coupling agents, which are also reviewed. Although plasma treatment leads to remarkably improved surface wettability, this was not the case for chitosan-coated samples, where a wide range of wettability was reported ranging from almost superhydrophilic to hydrophobic, which may have a negative effect on the formation of chitosan-based hydrogels.

Regulable Polyelectrolyte-Surfactant Complex for Antibacterial Biomedical Catheter Coating via a Readily Scalable Route

Constructing multifunctional surfaces is one of the practical approaches to address catheter-related multiple complications but is generally time-consuming and substrate-dependent. Herein, a novel anti-adhesion, antibacterial, low friction, and robustness coating on medical catheters are developed via a universal and readily scalable method based on a regulable polyelectrolyte surfactant complex. The complex is rapidly assembled in one step by electrostatic and hydrophobic interactions between organosilicon quaternary ammonium surfactant (N⁺ _Si ) and adjustable polyelectrolyte with cross-linkable, anti-adhesive, and anionic groups. The alcohol-soluble feature of the complex is conducive to the rapid formation of coatings on any medical device with arbitrary shapes via dip coating. Different from the conventional polyelectrolyte-surfactant complex coating, the regulated complex coating with nonleaching mode could be stable in harsh conditions (high concentration salt solution, organic reagents, etc.) because of the cross-linked structure while improving the biocompatibility and reducing the adhesion of various bacteria, proteins, and blood cells. The coated catheter exhibits good antibacterial infection in vitro and in vivo, owing to the synergistic effect of N⁺ _Si and zwitterionic groups. Therefore, the rationally designed complex supplies a facile coating approach for the potential development in combating multiple complications of the medical catheter.

Self-Disinfecting Urethral Catheter to Overcome Urinary Infections: From Antimicrobial Photodynamic Action to Antibacterial Biochemical Entities

Medical-device-related infections are considered a worldwide public health problem. In particular, urinary catheters are responsible for 75% of cases of hospital urinary infections (a mortality rate of 2.3%) and present a high cost for public and private health systems. Some actions have been performed and described aiming to avoid it, including clinical guidelines for catheterization procedure, antibiotic prophylaxis, and use of antimicrobial coated-urinary catheters. In this review paper, we present and discuss the functionalization of urinary catheters surfaces with antimicrobial entities (e.g., photosensitizers, antibiotics, polymers, silver salts, oxides, bacteriophage, and enzymes) highlighting the immobilization of photosensitizing molecules for antimicrobial photodynamic applications. Moreover, the characterization techniques and (photo)antimicrobial effects of the coated-urinary catheters are described and discussed. We highlight the most significant examples in the last decade (2011-2021) concerning the antimicrobial coated-urinary catheter and their potential use, limitations, and future perspectives.

Assembly of surface-independent polyphenol/liquid gallium composite nanocoatings

The development of functional nanocoatings using natural compounds is a hallmark of sustainable strategies in the field of green synthesis. Herein, we report a surface-independent nanocoating strategy using natural polyphenols and gallium-based room temperature liquid metal nanoparticles. The nanocoating matrix is composed of tannic acid, crosslinked with group (IV) transition metal ions. Liquid gallium nanoparticles are incorporated into the coatings as a gallium ion releasing depot. The coating deposition is rapid and can be applied to a range of substrates including glass, plastics, paper, and metal surfaces, owing to the versatile adhesive nature of the catechol/gallol functional groups of tannic acid. The coating thickness can be controlled from 100 to 700 nm and the content of liquid gallium nanoparticles can be modulated. This enables the tunable release behaviour of gallium ions into the surrounding from the composite coatings. The coatings are highly biocompatible and display antioxidant and antibacterial properties that can be useful for diverse applications.

Loading of Polydimethylsiloxane with a Human ApoB-Derived Antimicrobial Peptide to Prevent Bacterial Infections

Background: medical device-induced infections affect millions of lives worldwide and innovative preventive strategies are urgently required. Antimicrobial peptides (AMPs) appear as ideal candidates to efficiently functionalize medical devices surfaces and prevent bacterial infections. In this scenario, here, we produced antimicrobial polydimethylsiloxane (PDMS) by loading this polymer with an antimicrobial peptide identified in human apolipoprotein B, r(P)ApoB_L^Pro. Methods: once obtained loaded PDMS, its structure, anti-infective properties, ability to release the peptide, stability, and biocompatibility were evaluated by FTIR spectroscopy, water contact angle measurements, broth microdilution method, time-killing kinetic assays, quartz crystal microbalance analyses, MTT assays, and scanning electron microscopy analyses. Results: PDMS was loaded with r(P)ApoB_L^Pro peptide which was found to be present not only in the bulk matrix of the polymer but also on its surface. ApoB-derived peptide was found to retain its antimicrobial properties once loaded into PDMS and the antimicrobial material was found to be stable upon storage at 4 °C for a prolonged time interval. A gradual and significant release (70% of the total amount) of the peptide from PDMS was also demonstrated upon 400 min incubation and the antimicrobial material was found to be endowed with anti-adhesive properties and with the ability to prevent biofilm attachment. Furthermore, PDMS loaded with r(P)ApoB_L^Pro peptide was found not to affect the viability of eukaryotic cells. Conclusions: an easy procedure to functionalize PDMS with r(P)ApoB_L^Pro peptide has been here developed and the obtained functionalized material has been found to be stable, antimicrobial, and biocompatible.

Investigation of the supportive therapy potential of propolis extract and Lactobacillus acidophilus LA-5 milk combination against breast cancer in mice

Immunotherapy has been applied in cancer treatments for many years as an alternative treatment method to radiotherapy, chemotherapy. It is well known that immunotherapy could suppress tumor formation by modulating the immune system of the host. The aim of the study is to investigate supportive therapy potential of acidophilus milk (AS) and propolis extract (PE) in the mouse xenograft breast cancer model. For this purpose, firstly cytotoxic effect of PE was determined by MTT assay against 4 T1 mouse breast cancer cells. Apoptotic effect of PE analyzed by flow cytometry. The antibacterial activity of PE was determined by the 96-well microplate broth-dilution method on Lactobacillus acidophilus LA-5. Then, Balb/c mice were injected subcutaneously with 4 T1 cells (2x10⁵ cells/mouse) and also mice were given daily oral gavage with PE (66 mg/kg/day) and/or acidophilus milk (10⁸ CFU/mL/mouse/day) for 14 days. The Balb/c mice were weighed throughout the study, and the tumor sizes were measured by caliper at the 14th day. The proliferation of splenocytes which collected spleen from mice was measured by MTT. CD8 + T cell response was analyzed by flow cytometry and results were evaluated in comparison with control and tumor control groups. The IC₅₀ value for PE on 4 T1 cells was determined as 129.25 ± 1.90 µg/mL. The apoptotic effect of PE at IC₅₀ concentration was determined as 3.3% of cells to late-apoptosis, 4.3% of cells to pro-apoptosis and 2.5% of cells to necrosis. The MIC and MBC values for PE on L. acidophilus LA-5 were 5000 ppm. The treatment of PE, AS and the combination of PE and AS were inhibited the tumor volumes by 59.16%, 28.29% and 63.39%, respectively. Acidophilus milk and PE combination significantly enhanced the ConA-, LPS- and PHA-induced splenocyte proliferation (P < 0.05). The acidophilus milk and PE combination were also found to stimulate IFN- γ production. In conclusion, the best anti-tumor effect was obtained by the combination of acidophilus milk and propolis.

Engineered Bioactive Polymeric Surfaces by Radiation Induced Graft Copolymerization: Strategies and Applications

The interest in developing antimicrobial surfaces is currently surging with the rise in global infectious disease events. Radiation-induced graft copolymerization (RIGC) is a powerful technique enabling permanent tunable and desired surface modifications imparting antimicrobial properties to polymer substrates to prevent disease transmission and provide safer biomaterials and healthcare products. This review aims to provide a broader perspective of the progress taking place in strategies for designing various antimicrobial polymeric surfaces using RIGC methods and their applications in medical devices, healthcare, textile, tissue engineering and food packing. Particularly, the use of UV, plasma, electron beam (EB) and γ-rays for biocides covalent immobilization to various polymers surfaces including nonwoven fabrics, films, nanofibers, nanocomposites, catheters, sutures, wound dressing patches and contact lenses is reviewed. The different strategies to enhance the grafted antimicrobial properties are discussed with an emphasis on the emerging approach of in-situ formation of metal nanoparticles (NPs) in radiation grafted substrates. The current applications of the polymers with antimicrobial surfaces are discussed together with their future research directions. It is expected that this review would attract attention of researchers and scientists to realize the merits of RIGC in developing timely, necessary antimicrobial materials to mitigate the fast-growing microbial activities and promote hygienic lifestyles.

The recent advances in surface antibacterial strategies for biomedical catheters

As one of the most common hospital-acquired infections, catheter-related infections (CRIs) which are caused by microbial colonization lead to increasing morbidity and mortality of patients and life threat for medical staffs. In this case, a variety of efforts have been made to design functional materials to limit bacterial colonization and biofilm formation. In this review, we focus on the recent advances in surface modification strategies of biomedical catheters used to prevent CRIs. The tests for the evaluation of the performances of modified catheters are listed. Future prospects of surface antibacterial strategies for biomedical catheters are also outlined.

Reduced Crystalline Biofilm Formation on Superhydrophobic Silicone Urinary Catheter Materials

Crystalline biofilm formation in indwelling urinary catheters is a serious health problem as it creates a barrier for antibacterial coatings. This emphasizes the failure of antibacterial coatings that do not have a mechanism to reduce crystal deposition on catheter surfaces. In this study, trifluoropropyl spray-coated polydimethylsiloxane (TFP-PDMS) has been employed as an antibiofilm forming surface without any antibacterial agent. Here, TFP was coated on half-cured PDMS using the spray coating technique to obtain a durable superhydrophobic coating for a minimum five cycles of different sterilization methods. The crystalline biofilm-forming ability of Proteus mirabilis in artificial urine, under static and flow conditions, was assessed on a TFP-PDMS surface. In comparison to the commercially available silver-coated latex and silicone catheter surfaces, TFP-PDMS displayed reduced bacterial attachment over 14 days. Moreover, the elemental analysis determined by atomic absorption spectroscopy and energy-dispersive X-ray analysis revealed that the enhanced antibiofilm forming ability of TFP-PDMS was due to the self-cleaning activity of the surface. We believe that this modified surface will significantly reduce biofilm formation in indwelling urinary catheters and further warrant future clinical studies.

Self-Limiting Mussel Inspired Thin Antifouling Coating with Broad-Spectrum Resistance to Biofilm Formation to Prevent Catheter-Associated Infection in Mouse and Porcine Models

Catheter-associated urinary tract infections (CAUTIs) are one of the most commonly occurring hospital-acquired infections. Current coating strategies to prevent catheter-associated biofilm formation are limited by their poor long-term efficiency and limited applicability to diverse materials. Here, the authors report a highly effective non-fouling coating with long-term biofilm prevention activity and is applicable to diverse catheters. The thin coating is lubricous, stable, highly uniform, and shows broad spectrum prevention of biofilm formation of nine different bacterial strains and prevents the migration of bacteria on catheter surface. The coating method is adapted to human-sized catheters (both intraluminal and extraluminal) and demonstrates long-term biofilm prevention activity over 30 days in challenging conditions. The coated catheters are tested in a mouse CAUTI model and demonstrate high efficiency in preventing bacterial colonization of both Gram-positive and Gram-negative bacteria. Furthermore, the coated human-sized Foley catheters are evaluated in a porcine CAUTI model and show consistent efficiency in reducing biofilm formation by Escherichia coli (E. coli) over 95%. The simplicity of the coating method, the ability to apply this coating on diverse materials, and the high efficiency in preventing bacterial adhesion increase the potential of this method for the development of next generation infection resistant medical devices.

In Situ Deposition of Green Silver Nanoparticles on Urinary Catheters under Photo-Irradiation for Antibacterial Properties

Urinary tract infections, especially catheter-associated urinary tract infections (CAUTIs), are the most common type of nosocomial infections. Patients with chronic indwelling urinary catheters have a higher risk of infection due to biofilm formation on the urinary catheter surface. Therefore, in this work, a novel, cost-effective antimicrobial urinary catheter was developed using green technology. Silver nanoparticles (AgNPs) synthesized from Mon Thong durian rind waste were used as an antimicrobial agent for the prevention of infection. Flavonoids, phenolic compounds, and glucose extracted from durian rind were used as a reducing agent to reduce the Ag+ dissolved in AgNO3 solution to form non-aggregated AgNPs under light irradiation. The AgNPs were simultaneously synthesized and coated on the inner and outer surfaces of silicone indwelling urinary catheters using the dip coating method. The results showed that the antimicrobial urinary catheter fabricated using a 0.3 mM AgNO3 concentration and 48 h coating time gave the highest antibacterial activity. The as-prepared spherical AgNPs with an average diameter of 9.1 ± 0.4 nm formed on catheter surfaces in a monolayer approximately 1.3 µm thick corresponding to a 0.712 mg/cm2 silver content. The AgNP layer was found to damage and almost completely inhibit the growth of Escherichia coli cells with antibacterial activity by 91%, equivalent to the commercial, high-price antimicrobial urinary catheter. The cumulative amount of silver released from the coated catheter through artificial urine over 10 days was about 0.040 µg/mL, which is less than the silver content that causes tissue and organ toxicity at 44 µg/mL. Thus, we concluded that the developed antimicrobial urinary catheter was useful in reducing the risk of infectious complications in patients with indwelling catheters.

A Glance at Antimicrobial Strategies to Prevent Catheter-Associated Medical Infections

Urinary and intravascular catheters are two of the most used invasive medical devices; however, microbial colonization of catheter surfaces is responsible for most healthcare-associated infections (HAIs). Several antimicrobial-coated catheters are available, but recurrent antibiotic therapy can decrease their potential activity against resistant bacterial strains. The aim of this Review is to question the actual effectiveness of currently used (coated) catheters and describe the progress and promise of alternative antimicrobial coatings. Different strategies have been reviewed with the common goal of preventing biofilm formation on catheters, including release-based approaches using antibiotics, antiseptics, nitric oxide, 5-fluorouracil, and silver as well as contact-killing approaches employing quaternary ammonium compounds, chitosan, antimicrobial peptides, and enzymes. All of these strategies have given proof of antimicrobial efficacy by modifying the physiology of pathogens or disrupting their structural integrity. The aim for synergistic approaches using multitarget processes and the combination of both antifouling and bactericidal properties holds potential for the near future. Despite intensive research in biofilm preventive strategies, laboratorial studies still present some limitations since experimental conditions usually are not the same and also differ from biological conditions encountered when the catheter is inserted in the human body. Consequently, in most cases, the efficacy data obtained from in vitro studies is not properly reflected in the clinical setting. Thus, further well-designed clinical trials and additional cytotoxicity studies are needed to prove the efficacy and safety of the developed antimicrobial strategies in the prevention of biofilm formation at catheter surfaces.

A strategy to control colonization of pathogens: embedding of lactic acid bacteria on the surface of urinary catheter

Indwelling urinary catheterization is one of the major causes of urinary tract infection (UTI) in hospitalized patients worldwide. A catheter serves as a surface for the colonization and formation of biofilm by UTI-related pathogenic bacteria. To combat the biofilm formation on its surface, several strategies have already been employed such as coating it with antibiofilm and antimicrobial compounds. For instance, the application of lactic acid bacteria (LAB) offers a potential strategy for the treatment of biofilm formation on the surface of the urinary catheter due to its ability to kill the pathogenic bacteria. The killing of pathogenic bacteria by LAB occurs via the production of antimicrobial compounds such as lactic acid, bacteriocin, and hydrogen peroxide. LAB also displays a competitive exclusion mechanism to prevent the adhesion of pathogens on the surfaces. Hence, LAB has been extensively applied as a bacteriotherapy to combat infectious diseases. Several strategies have been employed to attach LAB to a surface, but its easy detachment during long time exposure becomes one of the drawbacks in its application. Here, we have proposed a novel strategy for its adhesion on the surface of the urinary catheter with the utilization of mannose-specific adhesin (Msa) protein in a way similar as uropathogenic bacteria interacts between Msa present on the tip of the type I fimbriae/pilus and the mannose moieties on the host epithelial cell surfaces. KEY POINTS: • Urinary tract infection (UTI) is one of the common hospital-acquired infections, which is associated with the application of an indwelling urinary catheter. • Based on the competitive exclusions properties of LAB, attachment of the LAB on the catheter surface would be a promising approach to control the formation of pathogenic biofilm. • The strategy employed for the adhesion of LAB is via a covalent interaction of its mannose-specific adhesin (Msa) protein to the mannose residues grafted on the catheter surface.

Natural-based Hydrogels: A Journey from Simple to Smart Networks for Medical Examination

Natural hydrogels, due to their unique biological properties, have been used extensively for various medical and clinical examinations that are performed to investigate the signs of disease. Recently, complex-crosslinking strategies improved the mechanical properties and advanced approaches have resulted in the introduction of naturally derived hydrogels that exhibit high biocompatibility, with shape memory and self-healing characteristics. Moreover, the creation of self-assembled natural hydrogels under physiological conditions has provided the opportunity to engineer fine-tuning properties. To highlight recent studies of natural-based hydrogels and their applications for medical investigation, a critical review was undertaken using published papers from the Science Direct database. This review presents different natural-based hydrogels (natural, natural-synthetic hybrid and complex-crosslinked hydrogels), their historical evolution, and recent studies of medical examination applications. The application of natural-based hydrogels in the design and fabrication of biosensors, catheters and medical electrodes, detection of cancer, targeted delivery of imaging compounds (bioimaging) and fabrication of fluorescent bioprobes is summarised here. Without doubt, in future, more useful and practical concepts will be derived to identify natural-based hydrogels for a wide range of clinical examination applications.

Nucleic Acid Hybrids as Advanced Antibacterial Nanocarriers

Conventional antibiotic therapy is often challenged by poor drug penetration/accumulation at infection sites and poses a significant burden to public health. Effective strategies to enhance the therapeutic efficacy of our existing arsenal include the use of nanoparticulate delivery platforms to improve drug targeting and minimize adverse effects. However, these nanocarriers are often challenged by poor loading efficiency, rapid release and inefficient targeting. Nucleic acid hybrid nanocarriers are nucleic acid nanosystems complexed or functionalized with organic or inorganic materials. Despite their immense potential in antimicrobial therapy, they are seldom utilized against pathogenic bacteria. With the emergence of antimicrobial resistance and the associated complex interplay of factors involved in antibiotic resistance, nucleic acid hybrids represent a unique opportunity to deliver antimicrobials against resistant pathogens and to target specific genes that control virulence or resistance. This review provides an unbiased overview on fabricating strategies for nucleic acid hybrids and addresses the challenges of pristine oligonucleotide nanocarriers. We report recent applications to enhance pathogen targeting, binding and control drug release. As multifunctional next-generational antimicrobials, the challenges and prospect of these nanocarriers are included.

Bactericidal Lubricating Synthetic Materials for Three-Dimensional Additive Assembly with Controlled Mechanical Properties

3D printable synthetic materials have been developed to realize desired surface and mechanical properties. Lubricating synthetic surfaces have broad technological impacts on many applications including food packaging, microfluidic systems, and biomedical devices. However, combining soft materials with lubricants leads to significant phase separation and swelling phenomena, together with lowered mechanical strength, impeding full utilization of lubricating synthetic surfaces with desired shapes in a highly controllable manner. Here, we report a new platform to create a 3D printable lubricant-polymer composite (3D-LUBRIC) for the seamless fabrication of multidimensional structures with diverse functionalities. The rationally designed lubricant-polymer mixtures including silica aerogel particles not only exhibit suitable rheological properties for direct ink writing without phase separation but also enable the deterministic additive assembly of heterogeneous materials, which have large mismatches of oil permeability, with no distinct shape distortion. While exhibiting excellent lubricating properties for a variety of liquids, 3D-LUBRIC shows tunable mechanical properties with desired functionalities, such as optical transparency, flexibility and stretchability, and anti-icing and antibacterial/bactericidal properties. We employ the proposed platform to fabricate self-cleanable containers and antibacterial/bactericidal medical tubes. Our platform can offer new opportunities for building low-adhesive, multifunctional synthetic materials with customized shapes for diverse applications.

Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections

Urinary catheters are common medical devices, whose main function is to drain the bladder. Although they improve patients’ quality of life, catheter placement predisposes the patient to develop a catheter-associated urinary tract infection (CAUTI). The catheter is used by pathogens as a platform for colonization and biofilm formation, leading to bacteriuria and increasing the risk of developing secondary bloodstream infections. In an effort to prevent microbial colonization, several catheter modifications have been made ranging from introduction of antimicrobial compounds to antifouling coatings. In this review, we discuss the effectiveness of different coatings in preventing catheter colonization in vitro and in vivo, the challenges in fighting CAUTIs, and novel approaches targeting host–catheter–microbe interactions.

Facile coating of urinary catheter with bio-inspired antibacterial coating

Formation of bacterial biofilm on indwelling urinary catheters usually causes catheter-associated urinary tract infections (CAUTIs) that represent high percent of nosocomial infections worldwide. Therefore, coating urinary catheter with antibacterial and antifouling coating using facile technique is in great demand. In this study, commercial urinary catheter was coated with a layer of the self-polymerized polydopamine which acts as active platform for the in situ formation of silver nanoparticle (AgNPs) on catheter surface. The formed coating was intensively characterized using spectroscopic and microscopic techniques. The coated catheter has the potential to release silver ion in a sustained manner with a concentration of about 2-4 μg ml-1. Disk diffusion test and colony forming unites assay verified the significant bactericidal potential of the AgNPs coated catheter against both gram-positive and gram-negative bacteria as a consequence of silver ion release. In contrast to commercial catheter, the AgNPs coated catheter prevented the adherence of bacterial cells and biofilm formation on their surfaces. Interestingly, scanning electron microscope investigations showed that AgNPs coated catheter possess greater antifouling potential against gram-positive bacteria than against gram-negative bacteria. Overall, the remarkable antibacterial and antifouling potential of the coated catheter supported the use of such facile approach for coating of different medical devices for the prevention of nosocomial infections.