Microbial adhesion onto implanted biomaterials and the subsequent formation of biofilms is one of the major causes of biomedical device failure. The use of antimicrobial and nonfouling coatings are two strategies for the prevention of the attachment and spreading of microorganisms on the surfaces of implantable materials. Antimicrobial surfaces containing covalently linked quaternary ammonium compounds (QACs) have proved to be able to efficiently kill a variety of microorganisms. [1][2][3][4][5][6][7] A major problem with QAC surfaces is the attachment of dead microorganisms remaining on antimicrobial coatings, which can trigger an immune response and inflammation, and block its antimicrobial functional groups. In addition, such antimicrobial coatings can not fulfill the requirements of nonfouling [8] and biocompatibility as implantable biomaterials. Poly(ethylene glycol) (PEG) derivatives [9][10][11][12][13][14] or zwitterionic polymers [15][16][17][18] have been extensively used as nonfouling materials to reduce bacterial attachment and biofilm formation. However, the susceptibility of PEG to oxidation damage has limited its long-term application in complex media. [11,19] We recently showed that zwitterionic materials such as poly(sulfobetaine methacrylate) (pSBMA) were able to dramatically reduce bacterial attachment and biofilm formation [18] and were highly resistant to nonspecific protein adsorption, even from undiluted blood plasma and serum. [20][21][22][23][24] Although zwitterionic coatings can reduce the initial attachment and delay colonization of microbes on surfaces, there is a possibility of introducing pathogenic microbes into the patient during implantation operations and catheter insertions, which results in the failure of implanted devices; the use of antimicrobial agents will then be necessary to eliminate these microbes. Surface-responsive materials have been developed for a broad spectrum of applications, [25] but it is still a great challenge to develop biocompatible materials that have both antimicrobial and nonfouling capabilities. To the best of our knowledge, no such materials have been reported to date.Herein we report a new switchable polymer surface coating, which combines the advantages of both nonfouling and cationic antimicrobial materials and overcomes their disadvantages (Figure 1). In this system, poly(N,N-dimethyl-N-(ethoxycarbonylmethyl)-N-[2'-(methacryloyloxy)ethyl]-ammonium bromide) (pCBMA-1 C2, cationic precursor) on a surface can kill greater than 99.9 % of Escherichia coli K12 in one hour, and 98 % of the dead bacterial cells can be released when the cationic derivatives are hydrolyzed to nonfouling zwitterionic polymers. pCBMA-1 C2 and control coatings were grafted by surface-initiated atom transfer radical polymerization (ATRP) onto a gold surface covered with initiators. The thicknesses of the obtained polymer coatings, as measured by atomic force microscopy (AFM), [26] were 26-32 nm (Table 1).The bactericidal activity of pCBMA-1 C2 surfaces was determined using E. co...