Hyaluronic Acid and Its Composites as a Local Antimicrobial/Antiadhesive Barrier

Abstract

Living in biofilms is probably the most common condition for bacteria and fungi and biofilm-related infections account for the majority of bacterial infectious diseases worldwide.Among others biofilm-related infections, those associated with implanted biomaterials have an enormous and still largely underestimated impact in orthopaedics and trauma, cardio-surgery and several other surgical disciplines.Given the limited efficacy of existing antibiotics in the prevention and treatment of bacterial biofilms, new strategies are needed to protect implants and host tissues, overcoming the striking ability of the microorganisms to adhere on different surfaces and to immediately protect themselves by forming the biofilm matrix.Adhesion is a necessary first step in microbial colonization and pathogenesis and provides a potential target for new preventive and treatment approach.Among various polymers, tested as antibacterial coatings, hyaluronic acid and some of its composites do offer a well-established long-term safety profile and a proven ability to reduce bacterial adhesion and biofilm formation.Aim of the present review is to summarize the available evidence concerning the antiadhesion/antibiofilm activity of hyaluronic acid and some of its derivatives to reduce/prevent bacterial adhesion and biofilm formation in various experimental and clinical settings.

Hyaluronic acid treatment outcome on the post-extraction wound healing in patients with poorly controlled type 2 diabetes: A randomized controlled split-mouth study

“…These results may be attributed to the ability of HA to reduce the penetration of bacteria into the tissue by creating barrier. Hyaluronic acid retains the water in aqueous solution and maintains the stiffness that acts as a antimictobal barrier, directly after HA application (15,23,24). Gocmen et al confirmed that HA has an anti-inflammatory effect and that it improves angiogenesis after one week following extraction (17).…”

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

“…To our knowledge, as there is no clear evidence showing the superiority of one antibiotic prophylaxis over another [55], it was decided to leave each center free to decide the prophylaxis on the basis of their experience and the regional microbiology, instead of imposing a fixed arbitrary regimen. Moreover, the main activity of the DAC hydrogel is thought to be its anti-adhesive effect, as recently reported [56], while the presence of the antibiotic in the hydrogel is intended to eventually kill the remaining planktonic bacteria and is ancillary to the main activity of the device. All things considered, the choice to leave the centers free to choose the type of antibiotic did finally provide homogeneous and comparable data and may actually better simulate the reallife possible clinical scenario once the DAC device will be available to market.…”

Local Antibacterial Implant Protection in Orthopedics and Trauma: What’s New?

“…The Defensive Antibacterial Coating (D.A.C.) hydrogel is the first antimicrobial coating specifically designed to protect a variety of biomaterials in orthopedics, traumatology, dentistry, and maxillofacial surgery [52,53]. The device is based on the ability of hyaluronic-based compounds to reduce bacterial adhesion and biofilm formation, and to protect against various infectious agents [54,55,56].…”