Biomaterial strategies to combat implant infections: new perspectives to old challenges

Abstract

Peri-implant infection is rapidly becoming anif not the mostimportant clinical challenge for indwelling medical devices. To alleviate the global rise in antibiotic use for the treatment of such infections, a plethora of biomaterials/bioengineering-based antimicrobial strategies are emerging to restrict or ideally to eliminate microbial adhesion and biofilm formation on implant surfaces. Yet, the development of such approaches faces specific challenges, like biocompatibility concerns, reduced antimicrobial effectiveness, long-term stability issues and antibiotic resistance development, which limit translation to the clinic. This review provides insights into the antimicrobial activity of current state-of-the-art biomaterial-based approaches to address the aforementioned issues. Translational research strategies and regulatory framework are also emphasised as key elements facilitating clinical implementation of anti-infective biomaterials. This review closes with the vision that the integration of computational tools and experimental databases using artificial intelligence (AI) would provide new insights for the accelerated development of next-generation biomaterial-based antimicrobial strategies.

Recent Advances in Antibacterial Coatings to Combat Orthopedic Implant-Associated Infections

“…Similar to other medical devices and implants, most orthopedic implants generally fail due to the development of IAIs and poor tissue interconnections [ 27 , 28 ]. Such poor host integration between the implants and their surrounding bone tissues may lead to the presence of small void spaces around implants, allowing a suitable environment for bacterial adhesion and colonization [ 5 , 7 , 12 , 26 ].…”

“…Molecules 2024, 29, x FOR PEER REVIEW 3 of 20 tissues may lead to the presence of small void spaces around implants, allowing a suitable environment for bacterial adhesion and colonization [5,7,12,26]. The four-stage biofilm formation process on medical implants is illustrated in Figure 1.…”

“…It is also increasing the economic burden across the EU with an annual healthcare cost of about EUR 1.5 billion per year. In the USA alone, IAIs account for 25% of all hospital-acquired infections and the annual healthcare burden exceeds USD 4 billion [ 9 , 10 , 11 , 12 ].…”

“…As the orthopedic implant market is expected to grow, the risk of associated infections should be minimized by preventing bacteria colonization at implants, and addressing therapeutic challenges related to development of biofilms, which are complex dense matrices of proteins, polysaccharides, and DNA-embedding bacteria [ 12 ]. The formation of biofilms at implants significantly impairs the efficacy of antibiotic treatment by increasing the antibiotic resistance of internal biofilm cells by 10–1000 times [ 18 ].…”

“…The former strategy focuses on preventing biofilm formation on the implants, whereas the latter focuses on disrupting bacterial cells and achieving efficient bacterial eradication. For achieving efficient action against both adhered and surrounding bacteria, the active bacteria killing strategy focuses on designing safe coatings for orthopedic implants capable of locally releasing antibacterial agents [ 12 , 23 ]. There is recent rapidly growing interest in this strategy for inhibiting biofilm formation on implants due to an increase of occurrence of superbacteria and resistance to conventional antibacterial agents [ 23 ].…”