Facile Surface Multi-Functionalization of Biomedical Catheters with Dual-Microcrystalline Broad-Spectrum Antibacterial Drugs and Antifouling Poly(ethylene glycol) for Effective Inhibition of Bacterial Infections

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.

Tackling catheter-associated urinary tract infections with next-generation antimicrobial technologies

Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.

The Construction of Alkaline Phosphatase-Responsive Biomaterial and Its Application for In Vivo Urinary Tract Infection Therapy

Urinary tract infections caused by urinary catheter implantations are becoming more serious. Therefore, the construction of a responsive antibacterial biomaterial that can not only provide biocompatible conditions, but also effectively prevent the growth and metabolism of bacteria, is urgently needed. In this work, a benzophenone-derived phosphatase light-triggered antibacterial agent is designed and synthesized, which is tethered to the biological materials using a one-step method for in vivo antibacterial therapy. This surface could kill gram-positive bacteria (Staphylococcus aureus) and gram-negative bacteria (Escherichia coli). More importantly, because this material exhibited a zwitterion structure, it does not damage blood cells and tissue cells. When the bacteria interact with this surface, the initial fouling of the bacteria is reduced by zwitterion hydration. When the bacteria actively accumulate and metabolize to produce a certain amount of alkaline phosphatase, the surface immediately started the sterilization performance, and the bactericidal effect is achieved by destroying the bacterial cell membrane. In summary, an antibacterial biomaterial that shows biocompatibility with mammalian cells is successfully constructed, providing new ideas for the development of intelligent urinary catheters.

Thermoresponsive Block Copolymer Core-Shell Nanoparticles with Tunable Flow Behavior in Porous Media

With the purpose of investigating new polymeric materials as potential flow modifiers for their future application in enhanced oil recovery (EOR), a series of amphiphilic poly(di(ethylene glycol) methyl ether methacrylate-co-oligo(ethylene glycol) methyl ether methacrylate) [P(DEGMA-co-OEGMA)]-based core-shell nanoparticles were prepared by aqueous reversible addition-fragmentation chain transfer-mediated polymerization-induced self-assembly. The developed nano-objects were shown to be thermoresponsive, demonstrating a reversible lower-critical solution temperature (LCST)-type phase transition with increasing solution temperature. Characterization of their thermoresponsive nature by variable-temperature UV-vis and dynamic light scattering analyses revealed that these particles reversibly aggregate when heated above their LCST and that the critical transition temperature could be accurately tuned by simply altering the molar ratio of core-forming monomers. Sandpack experiments were conducted to evaluate their pore-blocking performance at low flow rates in a porous medium heated at temperatures above their LCST. This analysis revealed that particles aggregated in the sandpack column and caused pore blockage with a significant reduction in the porous medium permeability. The developed aggregates and the increased pressure generated by the blockage were found to remain stable under the injection of brine and were observed to rapidly dissipate upon reducing the temperature below the LCST of each formulation. Further investigation by double-column sandpack analysis showed that the blockage was able to reform when re-heated and tracked the thermal front. Moreover, the rate of blockage formation was observed to be slower when the LCST of the injected particles was higher. Our investigation is expected to pave the way for the design of "smart" and versatile polymer technologies for EOR applications in future studies.

Recent Developments in Multifunctional Antimicrobial Surfaces and Applications toward Advanced Nitric Oxide-Based Biomaterials

Implant-associated infections arising from biofilm development are known to have detrimental effects with compromised quality of life for the patients, implying a progressing issue in healthcare. It has been a struggle for more than 50 years for the biomaterials field to achieve long-term success of medical implants by discouraging bacterial and protein adhesion without adversely affecting the surrounding tissue and cell functions. However, the rate of infections associated with medical devices is continuously escalating because of the intricate nature of bacterial biofilms, antibiotic resistance, and the lack of ability of monofunctional antibacterial materials to prevent the colonization of bacteria on the device surface. For this reason, many current strategies are focused on the development of novel antibacterial surfaces with dual antimicrobial functionality. These surfaces are based on the combination of two components into one system that can eradicate attached bacteria (antibiotics, peptides, nitric oxide, ammonium salts, light, etc.) and also resist or release adhesion of bacteria (hydrophilic polymers, zwitterionic, antiadhesive, topography, bioinspired surfaces, etc.). This review aims to outline the progress made in the field of biomedical engineering and biomaterials for the development of multifunctional antibacterial biomedical devices. Additionally, principles for material design and fabrication are highlighted using characteristic examples, with a special focus on combinational nitric oxide-releasing biomedical interfaces. A brief perspective on future research directions for engineering of dual-function antibacterial surfaces is also presented.

Versatile antibacterial surface with amphiphilic quaternized chitin-based derivatives for catheter associated infection prevention

Microbial colonization of catheter surfaces is responsible for most healthcare-associated infections. Quaternized chitin and chitosan have excellent antimicrobial and biocompatible properties and can be used to provide safe and prolonged protection for biomedical catheters. Herein, we prepared quaternized β-chitin derivative (QC)- and quaternized chitosan derivative (QCS)-based antimicrobial surfaces. The quaternized polysaccharides modified TPU surfaces exhibited hydrophilicity, good biocompatibility. Among these, QCS2-modified TPU exhibited excellent antibacterial properties against Gram-positive and Gram-negative bacteria, and prevented the adherence of bacteria compared with pristine TPU. The antibacterial activity of QCS2-modified surfaces maintained for 8 weeks under the condition of immersion in serum. An in vivo subcutaneous implantation experiment revealed 99.87% reduction of bacteria and reduced expression of inflammation-related factors in the surrounding tissue five days after implantation with QCS2-modified TPU. Therefore, quaternized polysaccharide-modified surfaces have promising potential in preventing medical catheter-associated infections.

Naked-eye sensing and target-guiding treatment of bacterial infection using pH-tunable multicolor luminescent lanthanide-based hydrogel

In this work, a pH-tunable multicolor luminescent lanthanide-based hydrogel (CS/DEX/CP) was prepared based on lanthanide coordination polymer (CP), dextran aldehyde (DEX) and chitosan (CS). The CP was obtained by the self-assembly of guanosine acid (GMP), ciprofloxacin (CIP), Eu³⁺, and Tb³⁺. As-prepared CS/DEX/CP hydrogel could emit blue, green, and red luminescence of CIP, Tb³⁺, and Eu³⁺, respectively. It was also found that the luminescence of CS/DEX/CP hydrogel exhibited visual color change in the pH range of 5.5 to 8. Such pH-sensitive hydrogel was multicolor-responsive to protons produced by bacterial growth, therefore, it could provide early warning of bacterial infection by naked-eye. In addition, the increased acidity resulted in not only the degradation of acid-labile Schiff base linkages between DEX and CS, but also the fracture of coordination between CIP and lanthanide ions. As a result, the released CIP and CS showed significantly antibacterial activity against both S. aureus and E. coli.

Benchtop Preparation of Polymer Brushes by SI-PET-RAFT: The Effect of the Polymer Composition and Structure on Inhibition of a Pseudomonas Biofilm

We report a high-throughput method for producing surface-tethered polymeric brushes on glass substrates via surface-initiated photoinduced electron transfer-reversible addition-fragmentation chain transfer polymerization (SI-PET-RAFT). Due to its excellent oxygen tolerance, SI-PET-RAFT allows brush growth using low reagent volumes (30 μL) without prior degassing. An initial 28 homopolymer brush library was successfully prepared and screened with respect to their antifouling performance. The high-throughput approach was further exploited to expand the library to encompass statistical, gradient, and block architectures to investigate the effect of monomer composition and distribution using two monomers of disparate performance. In this manner, the degree of attachment from Gram-negative Pseudomonas aeruginosa (PA) bacterial biofilms could be tuned between the bounds set by the homopolymer brushes.

A New Antibiotic-Loaded Sol-Gel can Prevent Bacterial Intravenous Catheter-Related Infections

The aim of this study was to evaluate the effectiveness of a moxifloxacin-loaded organic-inorganic sol-gel (A50) by locally preventing the catheter-related bloodstream infection (CRBSI) provoked by Staphylococcus epidermidis (S. epidermidis) and the effect resulting from its hydrolytic degradation on coagulation by using a rabbit in-vivo model. A50 coating can completely inhibit growth and would locally prevent CRBSI provoked by S. epidermidis. None of the coagulation blood parameters showed a significant difference constant over time between the control catheter group and the A50-coated catheter group, despite the visible silica release resulting from physiological A50 sol-gel degradation detected in serum at least during the first week. At pathological level, foreign body reaction was present in both of types of catheter, and it was characterized by the presence of macrophages and foreign body giant cell. However, this reaction was different in each group: the A50-coated catheter group showed a higher inflammation with histiocytes, which were forming granuloma-like aggregates with an amorphous crystalline material inside, accompanied by other inflammatory cells such as plasma cells, lymphocytes and mast cells. In conclusion, A50 coating a venous catheter showed excellent bactericidal anti-biofilm response since it completely inhibited S. epidermidis biofilm development and, far from showing procoagulant effects, showed slightly anticoagulant effects.

Facile Fabrication of Silicon(IV)Phthalocyanine-Embedded Poly(vinyl alcohol)-Based Antibacterial and Antifouling Interfaces

Interest in the photodynamic inactivation of bacteria as an alternative method to antibiotic treatment continues to grow. Based on this approach, light-activated anti-infective interfaces could be fabricated via incorporation of photosensitizers into the polymer-based materials. In order to combine photobactericidal and antifouling functions, the choice of the carrier polymer is of particular significance: it should enable fast and effective conjugation of photosensitizer and reduce the formation of bioburden on the artificial material in a biological environment. This study reports one-pot fabrication and characterization of two silicon(IV)phthalocyanine /poly(vinyl alcohol)-based electrospun mats. The method relies on the thermal cross-linking of components by esterification using sebacic acid as a cross-linking agent. Fabricated flexible mats showed photosensitizer-dependent antibacterial photoactivity against different Gram-positive bacteria with low cytotoxic effects on human fibroblasts and were effective against bacterial attachment, as an early step toward future biofilm formation. This work provides practical guidelines in developing photoactive materials and interfaces that can be used in nonadhesive wound dressings, food packaging, water, and air filtration.

Multifunctional Antibacterial Materials Comprising Water Dispersible Random Copolymers Containing a Fluorinated Block and Their Application in Catheters

Inhibiting the attachment of bacteria and the formation of biofilms on surfaces of materials and devices is the key to ensure public safety and is also the focus of attention and research. Here we report on the synthesis of multifunctional antibacterial materials based on water dispersible random copolymers containing a fluorinated block, poly(acrylic acid-co-1H,1H,2H,2H-perfluorododecyl acrylate) (PAA-co-PFDA), and poly(hexamethylene biguanide) hydrochloride (PHMB). PAA-co-PFDA copolymers were synthesized through a simple free radical polymerization. After lightly cross-linking of PAA-co-PFDA and complexation with PHMB, multifunctional antibacterial PAA-co-PFDA/PHMB complex nanoparticles were generated, which can form transparent coatings on various substrates. The resultant coating has aggregation-induced emission character which can be used to observe the uniformity of the coating on a catheter and has a potential application as a fluorescence probe. It has been demonstrated that the PAA-co-PFDA/PHMB complex nanoparticle coatings can resist bacterial adhesion in physiological environment and exhibit excellent antibacterial activity in infection environment. In vitro and in vivo experiments indicated that the PAA-co-PFDA/PHMB complex nanoparticle coated catheters exhibited excellent antibacterial activity and possessed good biocompatibility. This method is simple and scalable, which is important for future commercialization. The attractive multifunctional properties of the PAA-co-PFDA/PHMB complex nanoparticles, such as antifouling, antimicrobial, emission, and pH-responsive release character, have great potential application in a wide range of biomedical fields.

The synergistic effect of hierarchical structure and alkyl chain length on the antifouling and bactericidal properties of cationic/zwitterionic block polymer brushes

A well-organized hierarchical structure and appropriate alkyl chain length facilitate the synergistic anti-biofilm effect.

Self-adaptive antibacterial surfaces with bacterium-triggered antifouling-bactericidal switching properties

Self-adaptive antibacterial surfaces with bacterium-triggered antifouling-bactericidal switching properties were readily constructed for the therapy of catheter-associated infection.

Sodium triphosphate–capped silver nanoparticles on a decellularized scaffold-based polyurethane vascular patch for bacterial infection inhibition and rapid endothelialization

With increasing incidence rate of cardiovascular diseases and implant-related infections, there is growing demand for vascular patches that can promote endothelialization and resist bacterial infection. In this work, we immobilized sodium triphosphate–capped silver nanoparticles onto a polyurethane film to obtain a composite film and evaluated its in vitro biocompatibility. Subsequently, we anchored sodium triphosphate–capped silver nanoparticles onto a polyurethane-coated decellularized scaffold to prepare a vascular patch and investigated its in vivo performance in a mouse model. The prepared vascular patch demonstrated excellent biocompatibility and potent antibacterial activity against Escherichia coli and Staphylococcus aureus. It still maintained the surgical artery patency at 30 days after implantation. At the same time, the endothelialization at the surgical site was achieved, showing its ability to facilitate endothelialization. Therefore, it may be a promising candidate for combating bacterial infection and treating diseased blood vessels.

Biodegradable Antibacterial Polymeric Nanosystems: A New Hope to Cope with Multidrug-Resistant Bacteria

The human society is faced with daunting threats from bacterial infections. Over decades, a variety of antibacterial polymeric nanosystems have exhibited great promise for the eradication of multidrug-resistant bacteria and persistent biofilms by enhancing bacterial recognition and binding capabilities. In this Review, the "state-of-the-art" biodegradable antibacterial polymeric nanosystems, which could respond to bacteria environments (e.g., acidity or bacterial enzymes) for controlled antibiotic release or multimodal antibacterial treatment, are summarized. The current antibacterial polymeric nanosystems can be categorized into antibiotic-containing and intrinsic antibacterial nanosystems. The antibiotic-containing polymeric nanosystems include antibiotic-encapsulated nanocarriers (e.g., polymeric micelles, vesicles, nanogels) and antibiotic-conjugated polymer nanosystems for the delivery of antibiotic drugs. On the other hand, the intrinsic antibacterial polymer nanosystems containing bactericidal moieties such as quaternary ammonium groups, phosphonium groups, polycations, antimicrobial peptides (AMPs), and their synthetic mimics, are also described. The biodegradability of the nanosystems can be rendered by the incorporation of labile chemical linkages, such as carbonate, ester, amide, and phosphoester bonds. The design and synthesis of the degradable polymeric building blocks and their fabrications into nanosystems are also explicated, together with their plausible action mechanisms and potential biomedical applications. The perspectives of the current research in this field are also described.

Anti-biofilm surfaces from mixed dopamine-modified polymer brushes: synergistic role of cationic and zwitterionic chains to resist staphyloccocus aureus

The dominant amount of antifouling D-PSBMA with a minor amount of bactericidal D-PQAs facilitate the synergistic anti-biofilm effect.

“Imitative” click chemistry to form a sticking xerogel for the portable therapy of bacteria-infected wounds

Xerogels usually possess a stable structure and have a low swelling rate due to their inferior dynamics.