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

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.

Implants coating strategies for antibacterial treatment in fracture and defect models: A systematic review of animal studies

Objective

Fracture-related infection (FRI) remains a major concern in orthopaedic trauma. Functionalizing implants with antibacterial coatings are a promising strategy in mitigating FRI. Numerous implant coatings have been reported but the preventive and therapeutic effects vary. This systematic review aimed to provide a comprehensive overview of current implant coating strategies to prevent and treat FRI in animal fracture and bone defect models.

Methods

A literature search was performed in three databases: PubMed, Web of Science and Embase, with predetermined keywords and criteria up to 28 February 2023. Preclinical studies on implant coatings in animal fracture or defect models that assessed antibacterial and bone healing effects were included.

Results

A total of 14 studies were included in this systematic review, seven of which used fracture models and seven used defect models. Passive coatings with bacteria adhesion resistance were investigated in two studies. Active coatings with bactericidal effects were investigated in 12 studies, four of which used metal ions including Ag+ and Cu2+; five studies used antibiotics including chlorhexidine, tigecycline, vancomycin, and gentamicin sulfate; and the other three studies used natural antibacterial materials including chitosan, antimicrobial peptides, and lysostaphin. Overall, these implant coatings exhibited promising efficacy in antibacterial effects and bone formation.

Conclusion

Antibacterial coating strategies reduced bacterial infections in animal models and favored bone healing in vivo. Future studies of implant coatings should focus on optimal biocompatibility, antibacterial effects against multi-drug resistant bacteria and polymicrobial infections, and osseointegration and osteogenesis promotion especially in osteoporotic bone by constructing multi-functional coatings for FRI therapy.

The translational potential of this paper

The clinical treatment of FRI is complex and challenging. This review summarizes novel orthopaedic implant coating strategies applied to FRI in preclinical studies, and offers a perspective on the future development of orthopaedic implant coatings, which can potentially contribute to alternative strategies in clinical practice.

PHMB modified photothermally triggered nitric oxide release nanoplatform for precise synergistic therapy of wound bacterial infections

Bacterial infection has been considered as a significant obstacle for wound healing. Nitric oxide (NO), as a novel alternative for antibiotics, has emerged as a promising antibacterial agent. However, the precise spatiotemporal controlled release of NO still remains a major challenge. Herein, a near-infrared (NIR) light triggered NO release nanoplatform (designated as PB-NO@PDA-PHMB) with enhanced broad-spectrum antibacterial and anti-biofilm properties was constructed. Given that PB-NO@PDA-PHMB has strong absorption in the NIR region and exhibits excellent photothermal effect, it can rapidly trigger NO release by NIR irradiation. PB-NO@PDA-PHMB can effectively contact and capture bacteria, and then exhibit synergistic effect of photothermal and gas therapy. In vitro and in vivo experiments indicated that PB-NO@PDA-PHMB exhibited excellent biocompatibility, satisfactory synergistic antibacterial efficacy and the capability of accelerating wound healing. Under NIR irradiation (808 nm, 1 W cm^-2, 7 min), PB-NO@PDA-PHMB (80 μg mL^-1) achieved 100% bactericidal activity against both Gram-negative bacteria Escherichia coli (E. coli) and Gram-positive bacteria Staphyloccocus aureus (S. aureus), removed 58.94% of S. aureus biofilm. Therefore, this all-in-one antibacterial nanoplatform with high NIR responsiveness provides a promising antibiotic-free strategy for bacterial infection treatment.

Antibacterial coatings on orthopedic implants

With the aging of population and the rapid improvement of public health and medical level in recent years, people have had an increasing demand for orthopedic implants. However, premature implant failure and postoperative complications frequently occur due to implant-related infections, which not only increase the social and economic burden, but also greatly affect the patient's quality of life, finally restraining the clinical use of orthopedic implants. Antibacterial coatings, as an effective strategy to solve the above problems, have been extensively studied and motivated the development of novel strategies to optimize the implant. In this paper, a variety of antibacterial coatings recently developed for orthopedic implants were briefly reviewed, with the focus on the synergistic multi-mechanism antibacterial coatings, multi-functional antibacterial coatings, and smart antibacterial coatings that are more potential for clinical use, thereby providing theoretical references for further fabrication of novel and high-performance coatings satisfying the complex clinical needs.

Temperature-triggered fluorocopolymer aggregate coating switching from antibacterial to antifouling and superhydrophobic hemostasis

The multifunction antibacterial hemostatic materials can reduce blood loss, infection and wound complications, which probably decrease morbidity and health care costs. However, the contradictory relationship between antibacterial ability and biocompatibility, and the unnecessary blood loss restricts the practical application of hydrophilic cationic antibacterial hemostatic materials. Herein, a multifunctional temperature-triggered antibacterial hemostatic fluorocopolymer aggregate coating was developed. After self-assembly and quaternization process, the quaternized poly(N,N-dimethylaminoethylmethacrylate)-b-poly(1H,1H,2H,2H-heptadecafluorodecyl acrylate) block copolymers (PDMA-b-PFOEMA) aggregate coating consisting of fluoropolymer and quaternary ammonium salt were built. The synergistic effect on fluorinated block with low surface energy and quaternary ammonium salt block with bactericide activity severs the way of initial bacterial attachment and proliferation, while the migration of fluorinated block greatly promotes the biocompatibility and anti-adhesion performance in response to the switch from room temperature to physiological temperature. Furthermore, the fluorocopolymer aggregate coating with hydrophobic properties possessed the property of rapid coagulation, low blood loss, minor secondary bleeding and least bacteria infiltration. The multifunctional temperature-triggered fluorocopolymer aggregate coating with antifouling, antibacterial and hemostatic properties may have a great potential in the biomedical application.

Biomedical polymers: synthesis, properties, and applications

Biomedical polymers have been extensively developed for promising applications in a lot of biomedical fields, such as therapeutic medicine delivery, disease detection and diagnosis, biosensing, regenerative medicine, and disease treatment. In this review, we summarize the most recent advances in the synthesis and application of biomedical polymers, and discuss the comprehensive understanding of their property-function relationship for corresponding biomedical applications. In particular, a few burgeoning bioactive polymers, such as peptide/biomembrane/microorganism/cell-based biomedical polymers, are also introduced and highlighted as the emerging biomaterials for cancer precision therapy. Furthermore, the foreseeable challenges and outlook of the development of more efficient, healthier and safer biomedical polymers are discussed. We wish this systemic and comprehensive review on highlighting frontier progress of biomedical polymers could inspire and promote new breakthrough in fundamental research and clinical translation.

Multi-Stimulus Responsive Multilayer Coating for Treatment of Device-Associated Infections

Antibacterial coating with antibiotics is highly effective in avoiding device-associated infections (DAIs) which is an unsolved healthcare problem that causes significant morbidity and mortality rates. However, bacterial drug resistance caused by uncontrolled release of antibiotics seriously restricts clinical efficacy of antibacterial coating. Hence, a local and controlled-release system which can release antibiotics in response to bacterial infected signals is necessary in antibacterial coating. Herein, a multi-stimulus responsive multilayer antibacterial coating was prepared through layer-by-layer (LbL) self-assembly of montmorillonite (MMT), chlorhexidine acetate (CHA) and Poly(protocatechuic acid-polyethylene glycol 1000-bis(phenylboronic acid carbamoyl) cystamine) (PPPB). The coating can be covered on various substrates such as cellulose acetate membrane, polyacrylonitrile membrane, polyvinyl chloride membrane, and polyurethane membrane, proving it is a versatile coating. Under the stimulation of acids, glucose or dithiothreitol, this coating was able to achieve controlled release of CHA and kill more than 99% of Staphylococcus aureus and Escherichia coli (4 × 10⁸ CFU/mL) within 4 h. In the mouse infection model, CHA releasing of the coating was triggered by infected microenvironment to completely kill bacteria, achieving wounds healing within 14 days.

Facile fabrication of composite cellulose fibrous materials for efficient and consecutive dyeing wastewater treatment

Fabricating dye adsorbents with efficient adsorption properties is of great significance in the treatment of printing and dyeing wastewater. Herein, composite materials of polydopamine decorated cellulose fibrous nonwovens (PDA@CF NWs) were fabricated by constructing a PDA functional layer on the surface of cellulose fibers via in situ polymerization. In addition, a three-dimensional adsorbent of 3D PDA@CF NWs with good hydrophilicity, structural stability, and compression resistance could be obtained using a facilely laminating and traditional loop bonding reinforcing technique. Attributed to the efficient and uniform loading of an active PDA functional layer, the resulting PDA@CF NWs exhibited a relatively large adsorption capacity of around 91 mg g⁻¹ towards the template dye of methylene blue within a fast equilibrium time of 2 h, which was superior to most of the fibrous adsorbents. In addition, the treatment column of 3D PDA@CF NWs exhibited a breakthrough capacity of 40.9 mg g⁻¹, reaching nearly 50% of the static saturated dye-binding capacity. More importantly, the 3D PDA@CF NWs column could effectively and continuously separate the mixture of different dyes under gravity, highlighting an excellent practical performance. Thus, the PDA@CF NWs are expected to provide a promising candidate for environment-friendly, large-scale and efficient treatment of industrial printing and dyeing wastewater.

Composite materials of polydopamine decorated cellulose fibrous nonwovens were fabricated for efficient and consecutive dyeing wastewater treatment.

A sulfonate-based polypeptide toward infection-resistant coatings

Multifunctional coatings have gained significant attention for their promising potential to address the issue of medical device-related infections. However, they usually have multiple components in one layer which decreases the density of functional groups on surfaces and hence reduces the biological properties. Herein, we report a mono-component and sulfonate-based anionic polypeptide coating with on-demand antibacterial activity, antifouling property, and biocompatibility. The anionic polypeptide was prepared by ring-opening polymerization of L-cysteine-based N-carboxyanhydride (NCA) with allyl groups and a subsequent thiol-ene reaction to incorporate the sulfonate pendants. It adopted a 17.1-19.5% β-sheet conformation and self-assembled into a spherical nanoparticle. The polypeptide coating showed excellent in vitro antibacterial activity against both Gram-positive (i.e., S. aureus) and Gram-negative bacteria (i.e., E. coli) with >99% killing efficacy after acidic solution treatment and prominent antifouling property and biocompatibility after weak base treatment. An in vivo study revealed that the sulfonate-based polypeptide-coated polydimethylsiloxane (PDMS) exhibited good anti-infection property and histocompatibility.

Favorable Antibacterial, Antibiofilm, Antiadhesion to Cells, and Biocompatible Polyurethane by Facile Surface Functionalization

It is of paramount importance to prohibit biofilm formation in a wide range of implant devices, such as thermoplastic polyurethane (PU)-based catheters. It is possible only by means of a multifunctional material that provides fast and effective antibacterial activity, proper biocompatibility, and low bacterial and cell adhesion. In this paper, a facile chemistry approach has been developed to modify biomedical-grade PU with PU species, containing reactive uretdione functional groups for functionalization with the contact-type polyguanidine bactericidal agent and oxidized dextran as an antifouling polymer without sacrificing the thermal and mechanical properties. The resulting PU possesses broad-spectrum contact-active antibacterial activity against Gram-negative and Gram-positive bacteria with fast kinetics. The excellent antifouling capacity was confirmed by low nonspecific protein adsorption and reduced adhesion of fibroblast cells by ≥ 90%. In addition to antiadhesive and antibiofilm properties, high cell viability (>90%) and low hemolysis rate (HR < 1%) verified favorable cytocompatibility. Hence, the strategy followed to functionalize PUs in this paper might be considered to modify PU-based biomedical devices.

Nanotechnology-Based Antimicrobial and Antiviral Surface Coating Strategies

Biocontamination of medical devices and implants is a growing issue that causes medical complications and increased expenses. In the fight against biocontamination, developing synthetic surfaces, which reduce the adhesion of microbes and provide biocidal activity or combinatory effects, has emerged as a major global strategy. Advances in nanotechnology and biological sciences have made it possible to design smart surfaces for decreasing infections. Nevertheless, the clinical performance of these surfaces is highly depending on the choice of material. This review focuses on the antimicrobial surfaces with functional material coatings, such as cationic polymers, metal coatings and antifouling micro-/nanostructures. One of the highlights of the review is providing insights into the virus-inactivating surface development, which might particularly be useful for controlling the currently confronted pandemic coronavirus disease 2019 (COVID-19). The nanotechnology-based strategies presented here might be beneficial to produce materials that reduce or prevent the transmission of airborne viral droplets, once applied to biomedical devices and protective equipment of medical workers. Overall, this review compiles existing studies in this broad field by focusing on the recent related developments, draws attention to the possible activity mechanisms, discusses the key challenges and provides future recommendations for developing new, efficient antimicrobial and antiviral surface coatings.

Surface Fluorination Modification and Anti-Biofouling Study of a pHEMA Hydrogel

A poly(2-hydroxyethyl methacrylate) (pHEMA) hydrogel film was prepared by bulk polymerization. Then, it was surface modified by perfluorooctanoyl chloride to improve the anti-biofouling properties. Attenuated total reflectance-Fourier transform infrared (ATR-FTIR), X-ray photoelectron spectroscopy (XPS), scanning electron microscopy-energy dispersive X-ray spectroscopy (SEM-EDXS), and atomic force microscopy (AFM) analyses demonstrated that the uniform dense fluorinated layer had been successfully grafted onto pHEMA. The water contact angle (WCA) of the modified pHEMA film increased to 135°, while the surface energy decreased to 13.32 mN/m. The protein and bacterial adhesion properties of the modified pHEMA were decreased significantly. The in vitro cytotoxicity showed that the modified pHEMA was noncytotoxic. Thus, the fluorinated modification on the material surface was a convenient and effective method to establish a hydrophobic and anti-biofouling surface.

Recent advances in pH-responsive nanomaterials for anti-infective therapy

The design and synthesis of pH-responsive antibacterial nanomaterials and their applications in anti-infective therapy.