The potential of chitosan-silver nanoparticle-graphene oxide hybrid as an antimicrobial therapy against uropathogenic resistance in urinary tract infections

Abstract

Urinary tract infections (UTIs) are among the most common infections globally, with 150-250 million annual cases. In recent years, there has been an emerging trend of complicated UTIs, partly due to the resistance of uropathogens to commonly used first-line antibiotics. At its worst, antimicrobial resistance increases in-patient time, treatment costs, and the risk of complications and mortality. Resistance also gravely reduces treatment options. The writers review the literature published in 2013-2023 found on Pubmed, EBSCO-Host, and Google Scholar using several combination keywords: "new treatment," "urinary tract infection," "bacteria," "antimicrobial," and "resistance." Thirty-three in-vitro, three animal models (in-vivo), and one multicentre cohort study were found on the composite chitosan, silver nanoparticle, and graphene oxide (Chit-AgNP-GO), and its components. This bioactive material possesses a bactericidal and bacteriostatic effect against Gram-positive and Gram-negative uropathogens. Chit-AgNP-GO has multiple mechanisms of action for each component involved, with literature suggesting good antimicrobial activity for each. Silver destroys bacterial enzymes necessary for electron transfer, disrupts DNA synthesis, and destroys proteins integral to the bacterial structure. Chitosan facilitates adhesion to bacterial cell membranes and can contribute to bacterial cellular leakage. Graphene oxide affects bacterial liposolubility and permeability. The multiple mechanisms of action generated by this antimicrobial make it a promising agent to study in UTI cases, especially those complicated by uropathogenic resistance. However, validating this nanomaterial may be challenging due to the limited number of clinical studies. Therefore further in vivo, and clinical research protocols are highly required to confirm its antimicrobial potential in the clinical setting.