In Vitro and In Vivo Effectiveness of an Innovative Silver-Copper Nanoparticle Coating of Catheters To Prevent Methicillin-Resistant Staphylococcus aureus Infection

Recent developments in preventing catheter-related infections based on biofilms: A comprehensive review

Urinary and vascular catheters are among the most commonly used medical devices. However, infections caused by biofilm formation on the surface of catheters are a major cause of healthcare-associated infections. Traditional methods, such as using antimicrobials to prevent such infections, generally have short-term effects, and treatment is challenging owing to the emergence of antimicrobial-resistant bacteria. This review aims to evaluate the limitations of conventional catheter-related infection prevention efficacy, such as currently used antimicrobials, and analyze the efficacy and limitations of potential alternatives to prevent catheter-related infections that have not yet been commercialized, classified by the transition stages of biofilm formation. We intend to provide profound insights into the ideal technologies for preventing catheter-associated tract infections and present perspectives on future directions in this field.

Exploring Nitrogen-Functionalized Graphene Composites for Urinary Catheter Applications

Graphene has been broadly studied, particularly for the fabrication of biomedical devices, owing to its physicochemical and antimicrobial properties. In this study, the antibiofilm efficacy of graphene nanoplatelet (GNP)-based composites as coatings for urinary catheters (UCs) was investigated. GNPs were functionalized with nitrogen (N-GNP) and incorporated into a polydimethylsiloxane (PDMS) matrix. The resulting materials were characterized, and the N-GNP/PDMS composite was evaluated against single- and multi-species biofilms of Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Both biofilm cell composition and structure were analyzed. Furthermore, the antibacterial mechanisms of action of N-GNP were explored. The N-GNP/PDMS composite showed increased hydrophobicity and roughness compared to PDMS. In single-species biofilms, this composite significantly reduced the number of S. aureus, P. aeruginosa, and K. pneumoniae cells (by 64, 41, and 29%, respectively), and decreased S. aureus biofilm culturability (by 50%). In tri-species biofilms, a 41% reduction in total cells was observed. These results are aligned with the outcomes of the biofilm structure analysis. Moreover, N-GNP caused changes in membrane permeability and triggered reactive oxygen species (ROS) synthesis in S. aureus, whereas in Gram-negative bacteria, it only induced changes in cell metabolism. Overall, the N-GNP/PDMS composite inhibited biofilm development, showing the potential of these carbon materials as coatings for UCs.

ZnO-based Cu metal-organic framework (MOF) nanocomposite for boosting and tuning the photocatalytic degradation performance

Although metal-organic frameworks (MOFs) are a viable choice for photocatalysts with large surface area and tunable pore structure, the rapid recombination of excited photogenerated charges results in low activity towards photodegradation. Aiming at improving the photocatalytic activities of MOFs, different strategies to incorporate MOF with light-harvesting semiconductors have been developed. In this research, we report an effective photocatalyst designed by incorporating Cu-MOF with ZnO for the photocatalytic degradation of Rose Bengal exhibiting excellent degradation efficiency of 97.4% in 45 min under natural sunlight with catalyst dosage of 320 mg/L. The optical, morphology and surface characteristics of the prepared nanocomposite were studied using scanning electron microscopy (SEM-EDX), high-resolution transmission electron microscopy (HRTEM), powder X-ray diffraction (PXRD), Brunauer-Emmett-Teller (BET) analysis, thermogravimetric (TGA) analysis, Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS) and ultraviolet diffused reflectance spectroscopy (UV-DRS) techniques. Further studies showed that the degradation followed first-order kinetics with a rate constant of 0.077869 min-1. The degradation mechanism was investigated by photoluminescence (PL) study, XPS, zeta potential and quenching experiment in presence of different scavengers. Meanwhile, the fabricated composite displayed good recovery and reuse properties up to 5 cycles as revealed by XRD analysis proving itself a potential MOF-based photocatalyst towards environmental remediation process.

Nanomaterials and Coatings for Managing Antibiotic-Resistant Biofilms

Biofilms are a global health concern responsible for 65 to 80% of the total number of acute and persistent nosocomial infections, which lead to prolonged hospitalization and a huge economic burden to the healthcare systems. Biofilms are organized assemblages of surface-bound cells, which are enclosed in a self-produced extracellular polymer matrix (EPM) of polysaccharides, nucleic acids, lipids, and proteins. The EPM holds the pathogens together and provides a functional environment, enabling adhesion to living and non-living surfaces, mechanical stability, next to enhanced tolerance to host immune responses and conventional antibiotics compared to free-floating cells. Furthermore, the close proximity of cells in biofilms facilitates the horizontal transfer of genes, which is responsible for the development of antibiotic resistance. Given the growing number and impact of resistant bacteria, there is an urgent need to design novel strategies in order to outsmart bacterial evolutionary mechanisms. Antibiotic-free approaches that attenuate virulence through interruption of quorum sensing, prevent adhesion via EPM degradation, or kill pathogens by novel mechanisms that are less likely to cause resistance have gained considerable attention in the war against biofilm infections. Thereby, nanoformulation offers significant advantages due to the enhanced antibacterial efficacy and better penetration into the biofilm compared to bulk therapeutics of the same composition. This review highlights the latest developments in the field of nanoformulated quorum-quenching actives, antiadhesives, and bactericides, and their use as colloid suspensions and coatings on medical devices to reduce the incidence of biofilm-related infections.

Biocide effect against SARS-CoV-2 and ESKAPE pathogens of a noncytotoxic silver-copper nanofilm

Nanometric materials with biocidal properties effective against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) and pathogenic bacteria could be used to modify surfaces, reducing the risk of touching transmission. In this work, we showed that a nanometric layer of bimetallic AgCu can be effectively deposited on polypropylene (PP) fibers. The virucidal properties of the AgCu nanofilm were evaluated by comparing the viral loads remaining on uncoated and coated PP after contact times between 2 and 24 h. Quantification of virion numbers for different initial concentrations indicated a reduction of more than 95% after 2 h of contact. The bactericidal action of the AgCu nanofilm was also confirmed by inoculating uncoated and coated PP with a pool of pathogenic bacteria associated with pneumonia (ESKAPE). Meanwhile, no cytotoxicity was observed for human fibroblasts and keratinocyte cells, indicating that the nanofilm could be in contact with human skin without threat. The deposition of the AgCu nanofilm on the nonwoven component of reusable cloth masks might help to prevent virus and bacterial infection while reducing the pollution burden related to the disposable masks. The possible mechanism of biocide contact action was studied by quantum chemistry calculations that show that the addition of Ag and/or Cu makes the polymeric fiber a better electron acceptor. This can promote the oxidation of the phospholipids present at both the virus and bacterial membranes. The rupture at the membrane exposes and damages the genetic material of the virus. More studies are needed to determine the mechanism of action, but the results reported here indicate that Cu and Ag ions are good allies, which can help protect us from the virus that has caused this disturbing pandemic.

Advances in the Application of Nanomaterials as Treatments for Bacterial Infectious Diseases

Bacteria-targeting nanomaterials have been widely used in the diagnosis and treatment of bacterial infectious diseases. These nanomaterials show great potential as antimicrobial agents due to their broad-spectrum antibacterial capacity and relatively low toxicity. Recently, nanomaterials have improved the accurate detection of pathogens, provided therapeutic strategies against nosocomial infections and facilitated the delivery of antigenic protein vaccines that induce humoral and cellular immunity. Biomaterial implants, which have traditionally been hindered by bacterial colonization, benefit from their ability to prevent bacteria from forming biofilms and spreading into adjacent tissues. Wound repair is improving in terms of both the function and prevention of bacterial infection, as we tailor nanomaterials to their needs, select encapsulation methods and materials, incorporate activation systems and add immune-activating adjuvants. Recent years have produced numerous advances in their antibacterial applications, but even further expansion in the diagnosis and treatment of infectious diseases is expected in the future.

Effects of Mullite, Maghemite, and Silver Nanoparticles Incorporated in β-Wollastonite on Tensile Strength, Magnetism, Bioactivity, and Antimicrobial Activity

β-wollastonite (βW) has sparked much interest in bone defect recovery and regeneration. Biomaterial-associated infections and reactions between implants with human cells have become a standard clinical concern. In this study, a green synthesized βW, synthesized from rice husk ash and a calcined limestone precursor, was incorporated with mullite, maghemite, and silver to produce β wollastonite composite (βWMAF) to enhance the tensile strength and antibacterial properties. The addition of mullite to the βWMAF increased the tensile strength compared to βW. In vitro bioactivity, antibacterial efficacy, and physicochemical properties of the β-wollastonite and βWMAF were characterized. βW and βWMAF samples formed apatite spherules when immersed in simulated body fluid (SBF) for 1 day. In conclusion, βWMAF, according to the tensile strength, bioactivity, and antibacterial activity, was observed in this research and appropriate for the reconstruction of cancellous bone defects.

Self-defending additively manufactured bone implants bearing silver and copper nanoparticles

Effective preventive measures against implant-associated infection (IAI) are desperately needed. Therefore, the development of self-defending implants with intrinsic antibacterial properties has gained significant momentum. Biomaterials biofunctionalized with silver (Ag) have resulted in effective antibacterial biomaterials, yet regularly induce cytotoxicity. In this study, the use of both Ag and copper (Cu) nanoparticles (NPs) on TiO2 surfaces was investigated to generate antibacterial and osteoconductive biomaterials. Hence, additively manufactured Ti-6Al-4V volume-porous implants were biofunctionalized with plasma electrolytic oxidation (PEO) through the incorporation of varying ratios of Ag and/or Cu NPs in the TiO2 layer covering the implant surface. For all experimental groups, the surface morphology, chemical composition, ion release profile, generation of reactive ion species, antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) in vitro and ex vivo, as well as the response of pre-osteoblastic MC3T3-E1 cells in metabolic activity and differentiation assays were determined. PEO biofunctionalization resulted in rough and highly porous surfaces that released Ag and Cu ions for 28 days and generated hydroxyl as well as methyl radicals. A strong synergistic bactericidal behavior between Ag and Cu ions was detected, which allowed to decrease the concentration of Ag ions by 10-fold, while maintaining the same level of antibacterial activity. Antibacterial agar diffusion and quantitative assays indicated strong antibacterial activity in vitro for the implants containing Ag and Ag/Cu, while no antibacterial activity was observed for implants bearing only Cu NPs. Moreover, the biofunctionalized implants with ratios of up to 75% Ag and 25% Cu NP totally eradicated all bacteria in an ex vivo model using murine femora. Meanwhile, the biofunctionalized implants did not show any signs of cytotoxicity, while implants bearing only Cu NPs improved the metabolic activity after 7 and 11 days. The biomaterials developed here, therefore, exploit the synergistic behavior of Ag and Cu to simultaneously offer strong antibacterial behavior while fully mitigating the cytotoxicity of Ag against mammalian cells.

Antimicrobial Properties of the Ag, Cu Nanoparticle System

Microbes, including bacteria and fungi, easily form stable biofilms on many surfaces. Such biofilms have high resistance to antibiotics, and cause nosocomial and postoperative infections. The antimicrobial and antiviral behaviors of Ag and Cu nanoparticles (NPs) are well known, and possible mechanisms for their actions, such as released ions, reactive oxygen species (ROS), contact killing, the immunostimulatory effect, and others have been proposed. Ag and Cu NPs, and their derivative NPs, have different antimicrobial capacities and cytotoxicities. Factors, such as size, shape and surface treatment, influence their antimicrobial activities. The biomedical application of antimicrobial Ag and Cu NPs involves coating onto substrates, including textiles, polymers, ceramics, and metals. Because Ag and Cu are immiscible, synthetic AgCu nanoalloys have different microstructures, which impact their antimicrobial effects. When mixed, the combination of Ag and Cu NPs act synergistically, offering substantially enhanced antimicrobial behavior. However, when alloyed in Ag-Cu NPs, the antimicrobial behavior is even more enhanced. The reason for this enhancement is unclear. Here, we discuss these results and the possible behavior mechanisms that underlie them.

Update on Interfacial Charge Transfer (IFTC) Processes on Films Inactivating Viruses/Bacteria under Visible Light: Mechanistic Considerations and Critical Issues

This review presents an update describing binary and ternary semiconductors involving interfacial charge transfer (IFCT) in composites made up by TiO2, CuO, Ag2O and Fe2O3 used in microbial disinfection (bacteria and viruses). The disinfection mechanism, kinetics and generation of reactive oxygen species (ROS) in solution under solar/visible light are discussed. The surface properties of the photocatalysts and their active catalytic sites are described in detail. Pathogenic biofilm inactivation by photocatalytic thin films is addressed since biofilms are the most dangerous agents of spreading pathogens into the environment.

A polymer-based anti-quorum catheter coating to challenge MDR Staphylococcus aureus: in vivo and in vitro approaches

BACKGROUND

MDR Staphylococcus aureus is a major aetiological agent of catheter-associated infections. A quorum sensing targeted drug development approach proves to be an effective alternative strategy to combat such infections.

METHODS

Intravenous catheters were coated with polymethacrylate copolymers loaded with the antivirulent compound 2-[(methylamino)methyl]phenol (2MAMP). The in vitro drug release profile and kinetics were established. The anti-biofilm effect of the coated catheters was tested against clinical isolates of MDR S. aureus. The in vivo studies were carried out using adult male Wistar rats by implanting coated catheters in subcutaneous pockets. Histopathological analysis was done to understand the immunological reactions induced by 2MAMP.

RESULTS

A uniform catheter coating of thickness 0.1 mm was achieved with linear sustained release of 2MAMP for 6 h. The coating formulation was cytocompatible. The in vitro and in vivo anti-adherence studies showed reduced bacterial accumulation in coated catheters after 48 h. The histopathological results confirmed that the coated catheter did not bring about any adverse inflammatory response.

CONCLUSIONS

The developed anti-quorum-coated catheter that is non-toxic and biocompatible has the potential to be used in other medical devices, thereby preventing catheter-associated infections.

Antimicrobial Nanostructured Coatings: A Gas Phase Deposition and Magnetron Sputtering Perspective

Counteracting the spreading of multi-drug-resistant pathogens, taking place through surface-mediated cross-contamination, is amongst the higher priorities in public health policies. For these reason an appropriate design of antimicrobial nanostructured coatings may allow to exploit different antimicrobial mechanisms pathways, to be specifically activated by tailoring the coatings composition and morphology. Furthermore, their mechanical properties are of the utmost importance in view of the antimicrobial surface durability. Indeed, the coating properties might be tuned differently according to the specific synthesis method. The present review focuses on nanoparticle based bactericidal coatings obtained via magneton-spattering and supersonic cluster beam deposition. The bacteria–NP interaction mechanisms are first reviewed, thus making clear the requirements that a nanoparticle-based film should meet in order to serve as a bactericidal coating. Paradigmatic examples of coatings, obtained by magnetron sputtering and supersonic cluster beam deposition, are discussed. The emphasis is on widening the bactericidal spectrum so as to be effective both against gram-positive and gram-negative bacteria, while ensuring a good adhesion to a variety of substrates and mechanical durability. It is discussed how this goal may be achieved combining different elements into the coating.

Impediment to growth and yeast-to-hyphae transition in Candida albicans by copper oxide nanoparticles

The effects of two prominent copper oxide nanoparticles (CuO-NP and Cu₂O-NP), with the oxidation state of Cu⁺⁺ (cupric) and Cu⁺ (cuprous), on Candida albicans were evaluated. CuO-NP and Cu₂O-NP were synthesized and characterized by XRD, FESEM, HR-TEM and Zeta potential. At sub-MIC (50 µg ml^-1), both cupric and cuprous oxide NPs prevented yeast-to-hyphae switching and wrinkling behaviour in C. albicans. The mechanism for the antifungal action of the two NPs differed; CuO-NP significantly elicited reactive oxygen species, whereas membrane damage was more pronounced with Cu₂O-NP. Real time PCR analysis revealed that CuO-NP suppressed the morphological switching of yeast-to-hyphae by down-regulating cph1, hst7 and ras1 and by up-regulation of the negative regulator tup1. In comparison, Cu₂O-NP resulted in down-regulation of ras1 and up-regulation of the negative regulators nrg1 and tup1. Between the two NPs, CuO exhibited increased antifungal activity due to its stable oxidation state (Cu⁺⁺) and its smaller dimensions compared with Cu₂O-NP.

Synthesis and Application of Silver Nanoparticles (Ag NPs) for the Prevention of Infection in Healthcare Workers

Silver is easily available and is known to have microbicidal effect; moreover, it does not impose any adverse effects on the human body. The microbicidal effect is mainly due to silver ions, which have a wide antibacterial spectrum. Furthermore, the development of multidrug-resistant bacteria, as in the case of antibiotics, is less likely. Silver ions bind to halide ions, such as chloride, and precipitate; therefore, when used directly, their microbicidal activity is shortened. To overcome this issue, silver nanoparticles (Ag NPs) have been recently synthesized and frequently used as microbicidal agents that release silver ions from particle surface. Depending on the specific surface area of the nanoparticles, silver ions are released with high efficiency. In addition to their bactericidal activity, small Ag NPs (<10 nm in diameter) affect viruses although the microbicidal effect of silver mass is weak. Because of their characteristics, Ag NPs are useful countermeasures against infectious diseases, which constitute a major issue in the medical field. Thus, medical tools coated with Ag NPs are being developed. This review outlines the synthesis and utilization of Ag NPs in the medical field, focusing on environment-friendly synthesis and the suppression of infections in healthcare workers (HCWs).

Efficacy of β-phenylethylamine as a novel anti-microbial and application as a liquid catheter flush

With this study, we introduce a liquid flush for catheters and other tubing-based applications that consists of a solution of β-phenylethylamine (PEA) in tryptic soy broth. The initial experiments in multiwell polystyrene plates were conducted with Escherichia coli K-12 to assess the effectiveness of PEA at reducing planktonic growth, as well as the biomass and adenosine triphosphate (ATP) content of biofilm; PEA reduced these growth parameters as a function of increasing concentration. This effect was also seen in mutants of PEA catabolism, which leads us to believe that the PEA effect is due to PEA itself and not one of its degradation products. Since PEA reduced planktonic growth and biofilm when added at the time of inoculation, as well as at later time points, we propose PEA as a novel compound for the prevention and treatment of biofilm. PEA reduced planktonic growth and the ATP content of the biofilm for five bacterial pathogens, including an enterohemorrhagic E. coli, two uropathogenic E. coli, Pseudomonas aeruginosa and Staphylococcus aureus. A major finding of this study is the reduction of the ATP content of biofilm that formed in silicone tubing by periodic flushes of PEA. This experiment was performed to model antibiotic-lock treatment of an intravenous catheter. It was found that 10 mg ml^-1 of PEA reduced the ATP content of biofilm of five bacterial strains by 96.3 % or more after 2 weeks of incubation and three treatments with PEA. For P. aeruginosa, the reduction in ATP content was paralleled by an identical percentage reduction in viable cells in the biofilm.

Surface treatment strategies to combat implant-related infection from the beginning

Orthopaedic implants are recognised as important therapeutic devices in the successful clinical management of a wide range of orthopaedic conditions. However, implant-related infections remain a challenging and not uncommon issue in patients with implanted instrumentation or medical devices. Bacterial adhesion and formation of biofilm on the surface of the implant represent important processes towards progression of infection. Given the intimate association between infection and the implant surface, adequate treatment of the implant surface may help mitigate the risk of infection. This review summarises the current surface treatment technologies and their role in prevention of implant-related infection from the beginning.

Translational potential of this article

Despite great technological advancements, the prevalence of implant-related infections remains high. Four main challenges can be identified. (i) Insufficient mechanical stability can cause detachment of the implant surface coating, altering the antimicrobial ability of functionalized surfaces. (ii) Regarding drug-loaded coatings, a stable drug release profile is of vital importance for achieving effective bactericidal effect locally; however, burst release of the loaded antibacterial agents remains common. (iii) Although many coatings and modified surfaces provide superior antibacterial action, such functionalisation of surfaces sometimes has a detrimental effect on tissue biocompatibility, impairing the integration of the implants into the surrounding tissue. (iv) Biofilm eradication at the implant surface remains particularly challenging. This review summarised the recent progress made to address the aforementioned problems. By providing a perspective on state-of-the-art surface treatment strategies for medical implants, we hope to support the timely adoption of modern materials and techniques into clinical practice.

Biomedical Applications of Silver Nanoparticles: An Up-to-Date Overview

During the past few years, silver nanoparticles (AgNPs) became one of the most investigated and explored nanotechnology-derived nanostructures, given the fact that nanosilver-based materials proved to have interesting, challenging, and promising characteristics suitable for various biomedical applications. Among modern biomedical potential of AgNPs, tremendous interest is oriented toward the therapeutically enhanced personalized healthcare practice. AgNPs proved to have genuine features and impressive potential for the development of novel antimicrobial agents, drug-delivery formulations, detection and diagnosis platforms, biomaterial and medical device coatings, tissue restoration and regeneration materials, complex healthcare condition strategies, and performance-enhanced therapeutic alternatives. Given the impressive biomedical-related potential applications of AgNPs, impressive efforts were undertaken on understanding the intricate mechanisms of their biological interactions and possible toxic effects. Within this review, we focused on the latest data regarding the biomedical use of AgNP-based nanostructures, including aspects related to their potential toxicity, unique physiochemical properties, and biofunctional behaviors, discussing herein the intrinsic anti-inflammatory, antibacterial, antiviral, and antifungal activities of silver-based nanostructures.

The acute toxic effects of silver nanoparticles on myocardial transmembrane potential, INa and IK1 channels and heart rhythm in mice

This study focused on the potential toxicity of silver nanoparticles (AgNPs) on cardiac electrophysiology which is rarely investigated. We found that AgNPs (10^-9-10^-6g/ml) concentration-dependently depolarized the resting potential, diminished the action potential, and finally led to loss of excitability in mice cardiac papillary muscle cells in vitro. In cultured neonatal mice cardiomyocytes, AgNPs (10^-9-10^-7g/ml) concentration-dependently decreased the Na⁺ currents (I_Na), accelerated the activation, and delayed the inactivation and recovery of Na⁺ channels from inactivation within 5 min. AgNPs at 10^-8g/ml also rapidly decreased the inwardly rectifying K⁺ currents (I_K1) and delayed the activation of I_K1 channels. Intravenous injection of AgNPs at 3 mg/kg only decreased the heart rate, while at ≥4 mg/kg sequentially induced sinus bradycardia, complete atrio-ventricular conduction block, and cardiac asystole. AgNPs at 10^-10-10^-6g/ml did not increase reactive oxygen species (ROS) generation and only at 10^-6g/ml mildly induced lactate dehydrogenase (LDH) release in the cardiomyocytes within 5 min. Endocytosis of AgNPs by cardiomyocytes was not observed within 5 min, but was observed 1 h after exposing to AgNPs. Comparative Ag⁺ (≤0.02% of the AgNPs) could not induce above toxicities. We conclude that AgNPs exert rapid toxic effects on myocardial electrophysiology and induce lethal bradyarrhythmias. These acute toxicities are likely due to direct effects of AgNPs on ion channels at the nano-scale level, but not caused by Ag⁺, ROS, and membrane injury. These findings provide warning to the nanomedical practice using AgNPs.