Recent Progress in antibacterial hydrogel coatings for targeting biofilm to prevent orthopedic implant-associated infections

Abstract

The application of orthopedic implants for bone tissue reconstruction and functional restoration is crucial for patients with severe bone fractures and defects. However, the abiotic nature of orthopedic implants allows bacterial adhesion and colonization, leading to the formation of bacterial biofilms on the implant surface. This can result in implant failure and severe complications such as osteomyelitis and septic arthritis. The emergence of antibiotic-resistant bacteria and the limited efficacy of drugs against biofilms have increased the risk of orthopedic implant-associated infections (OIAI), necessitating the development of alternative therapeutics. In this regard, antibacterial hydrogels based on bacteria repelling, contact killing, drug delivery, or external assistance strategies have been extensively investigated for coating orthopedic implants through surface modification, offering a promising approach to target biofilm formation and prevent OIAI. This review provides an overview of recent advancements in the application of antibacterial hydrogel coatings for preventing OIAI by targeting biofilm formation. The topics covered include: (1) the mechanisms underlying OIAI occurrence and the role of biofilms in exacerbating OIAI development; (2) current strategies to impart anti-biofilm properties to hydrogel coatings and the mechanisms involved in treating OIAI. This article aims to summarize the progress in antibacterial hydrogel coatings for OIAI prevention, providing valuable insights and facilitating the development of prognostic markers for the design of effective antibacterial orthopedic implants.

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

“…Bacteria may invade the surgical site and induce infection. There is, therefore, a high risk of bacterial adhesion and colonization on orthopedic implants, leading eventually to biofilm infections [ 24 , 25 , 26 ]. Similar to other medical devices and implants, most orthopedic implants generally fail due to the development of IAIs and poor tissue interconnections [ 27 , 28 ].…”

“…Alteration in cell metabolism, either through chromosomal mutations or horizontal drug resistance gene transfer, can condense the biofilm and increase its tolerance, which is the capacity of a bacterial colony to endure lethal antibiotic levels in the short term, and resistance to antibiotics [ 24 ]. A relatively high bacterial population level in the biofilm matrix enhances interactions among the embedded bacterial cells through biochemical signaling pathways [ 24 ]. This close communication is generally associated with a facilitated exchange and horizontal transfer of virulence genes and resistance genes among microorganisms [ 34 , 36 ].…”

“…Thus, the adequate antibiotic dosing required for eliminating the encased bacteria can be hampered [32,35]. Alteration in cell metabolism, either through chromosomal mutations or horizontal drug resistance gene transfer, can condense the biofilm and increase its tolerance, which is the capacity of a bacterial colony to endure lethal antibiotic levels in the short term, and resistance to antibiotics [24]. A relatively high bacterial population level in the biofilm matrix enhances interactions among the embedded bacterial cells through biochemical signaling pathways The 3D complex biofilm matrix with unique physical and biological properties and inherent morphological features provides the pathogenic bacteria with an exceptional ability to avoid their killing by host defense components and antibiotics.…”

“…Considering the increased formation of antibiotic-resistant bacteria embedded on medical implants (particularly orthopedic implants), and the rise of complications associated with the surgical procedures and the long-term use of these implants, there is a recent growing interest in introducing new, safe, and effective strategies for combating IAIs [ 24 ]. In this contribution, we focus on recent advances in the development of surface implant modifications and development of antibacterial coatings.…”

Modern Microbiological Methods to Detect Biofilm Formation in Orthopedy and Suggestions for Antibiotic Therapy, with Particular Emphasis on Prosthetic Joint Infection (PJI)

“…Hydrophobic and super-hydrophobic surface treatment technologies have demonstrated a significant antibacterial repellent effect in preclinical studies [ 31 ]. Another possible coating is hydrogel coating, with can be improved and used as an antifouling, antibacterial, drug-loaded and light-responsive type [ 32 ]. Rivado et al characterized the promising strategy of using the anti-adhesion activity of biosurfactants produced by Bacillis spp.…”