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REVIEW

Recent Strategies and Future Recommendations for the Fabrication of Antimicrobial, Antibiofilm, and Antibiofouling Biomaterials

ORCID Icon &
Pages 3377-3405 | Received 26 Jan 2023, Accepted 06 May 2023, Published online: 21 Jun 2023

Figures & data

Figure 1 Pathogenic microbial biofilms contaminated biomaterials and biomedical devices induced infections.

Note: Adapted with permission from Lebeaux D, Ghigo JM. Management of biofilm-associated infections: what can we expect from recent research on biofilm lifestyles? Med Sci. 2012;28(8–9):727–739.Citation14
Figure 1 Pathogenic microbial biofilms contaminated biomaterials and biomedical devices induced infections.

Figure 2 Staphylococcus aureus adherence to the surface of biomaterials and biomedical devices.

Notes: Both reversible passive and irreversible active mechanisms culminate in bacterial adherence to the surface of biomaterials biomedical devices. The active process is mediated by sticky matrix molecules interacting with fibronectin and collagen. Cna and FnBPs stand for collagen-binding adhesin and fibronectin-binding proteins, respectively. Adapted from Arciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol. 2018;16(7):397–409, Copyright © 2018, with permission from Springer NatureCitation19 and created with BioRender.com.
Figure 2 Staphylococcus aureus adherence to the surface of biomaterials and biomedical devices.

Figure 3 Transitions in the development of a biofilm.

Notes: Following adherence, bacterial species interact to create microcolonies, promoting bacterial clustering and biofilm formation. Massive bacterial clusters known as towers form as the biofilm’s polymeric framework matures. Additionally, polysaccharide intracellular, extracellular DNA and many more structurally distinct extracellular matrix compounds can make up a biofilm. Adapted from Arciola CR, Campoccia D, Montanaro L. Implant infections: adhesion, biofilm formation and immune evasion. Nat Rev Microbiol. 2018;16(7):397–409, Copyright © 2018, with permission from Springer NatureCitation19 and created with BioRender.com.
Figure 3 Transitions in the development of a biofilm.

Figure 4 Biofilm formation on the biomedical device (catheter) mediated by conditioning film.

Notes: Adapted from J Hosp Infect, 98(2), Oliveira WF, Silva PMS, Silva RCS, et al, Staphylococcus aureus and Staphylococcus epidermidis infections on implants, 111–117, Copyright © 2018, with permission from ElsevierCitation45 and created with BioRender.com.
Figure 4 Biofilm formation on the biomedical device (catheter) mediated by conditioning film.

Figure 5 Schematic illustration of the biofouling of biomaterials and biomedical devices.

Notes: Depending on the surface characteristics of biomaterials and biomedical devices, protein adhesion unfolds. This may reveal receptor binding sites and enable cells to bind, resulting in a biological response dependent on the protein and cell types present in the immediate environment. Thrombosis and fibrosis are all examples of these responses. Adapted from Trends Biotechnol, 37(3), Mackie G, Gao L, Yau S, Leslie DC, Waterhouse A, Clinical Potential of Immobilized Liquid Interfaces: Perspectives on Biological Interactions, 268–280, Copyright © 2019, with permission from ElsevierCitation46 and created with BioRender.com.
Figure 5 Schematic illustration of the biofouling of biomaterials and biomedical devices.

Figure 6 Heparin-induced thrombocytopenia pathogenicity.

Notes: Platelets release the PF4 protein, which binds to heparin to synthesize PF4/heparin complexes. This complex stimulates beta cells to produce the IgG antibody, which further binds to the PF4/heparin complex. This immunological complex binds to Fc receptors and stimulates platelets, causing them to produce microparticles that start the thrombotic process. Reprinted from J Nurse Pract, 14(5), Roberts MK, Chaney S, Heparin-induced Thrombocytopenia, 402–408, Copyright © 2018, with permission from Elsevier.Citation74
Figure 6 Heparin-induced thrombocytopenia pathogenicity.

Figure 7 Biomaterial’s infection prevention strategies.

Notes: Adapted with permission from Zander ZK, Becker ML. Antimicrobial and Antifouling Strategies for Polymeric Medical Devices. ACS Macro Lett. 2017;7(1):16–25. Copyright © 2017 American Chemical SocietyCitation1 and created with BioRender.com.
Figure 7 Biomaterial’s infection prevention strategies.

Figure 8 (A) The three-step method of (i) anodic oxidation to produce the TiO2 nanotubes array, (ii) plasma immersion ion implantation to embed Ag nanoparticles into the TiO2 nanotubes, and (iii) vacuum extraction to loading vancomycin into the TiO2 nanotubes is shown schematically; (B) antibacterial activity in the bacteria/cells coculture model: SEM (scanning electron microscope) morphologies of bacteria and fibroblasts linked to the four samples. The photographs below are magnified more than the regions indicated by the red boxes. The bacteria are denoted by the blue arrow, whereas the green arrow marks the fibroblast; (C) fluorescence pictures of fibroblasts stained with DAPI (4′,6-diamidino-2-phenylindole) (blue) and TRITC (Tetramethylrhodamine isothiocyanate)-phalloidin (red) on four samples; (D) surface covers four distinct surfaces following three days of fibroblast cell attachment, spreading, and maturation (**P < 0.01, ***P < 0.001.); (E) schematic representation of the bacteria, fibroblasts, and sample processes. In vivo assessment of peri-implant soft tissues in four groups; (F) X-ray pictures of rabbits 15 days after surgery with different implants. The red oval indicates soft-tissue swelling, and groups NT-V and NT-Ag-V have little or no infectious symptoms; (G) inflammation of the peri-implant soft tissues was seen in all four groups; (H) gross scores of inflammation in the peri-implant soft tissues in four groups (***P < 0.001); (I) bacterial survival in soft tissues around the washer (*P < 0.05, **P < 0.01, ***P < 0.001); (J) a schematic depicting the antibacterial properties of the proposed surface, which has release-killing, contact-killing, and trap-killing capabilities; and (K) illustration depicting potential antibacterial and antibiofilm strategies in a concurrent cell-bacteria system on the titanium surface.

Notes: Reprinted with permission from Wang J, Li J, Qian S et al. Antibacterial Surface Design of Titanium-Based Biomaterials for Enhanced Bacteria-Killing and Cell-Assisting Functions Against Periprosthetic Joint Infection. ACS Appl Mater Interfaces. 2016;8(17):11,162–11,178. Copyright © 2016 American Chemical Society.Citation113
Figure 8 (A) The three-step method of (i) anodic oxidation to produce the TiO2 nanotubes array, (ii) plasma immersion ion implantation to embed Ag nanoparticles into the TiO2 nanotubes, and (iii) vacuum extraction to loading vancomycin into the TiO2 nanotubes is shown schematically; (B) antibacterial activity in the bacteria/cells coculture model: SEM (scanning electron microscope) morphologies of bacteria and fibroblasts linked to the four samples. The photographs below are magnified more than the regions indicated by the red boxes. The bacteria are denoted by the blue arrow, whereas the green arrow marks the fibroblast; (C) fluorescence pictures of fibroblasts stained with DAPI (4′,6-diamidino-2-phenylindole) (blue) and TRITC (Tetramethylrhodamine isothiocyanate)-phalloidin (red) on four samples; (D) surface covers four distinct surfaces following three days of fibroblast cell attachment, spreading, and maturation (**P < 0.01, ***P < 0.001.); (E) schematic representation of the bacteria, fibroblasts, and sample processes. In vivo assessment of peri-implant soft tissues in four groups; (F) X-ray pictures of rabbits 15 days after surgery with different implants. The red oval indicates soft-tissue swelling, and groups NT-V and NT-Ag-V have little or no infectious symptoms; (G) inflammation of the peri-implant soft tissues was seen in all four groups; (H) gross scores of inflammation in the peri-implant soft tissues in four groups (***P < 0.001); (I) bacterial survival in soft tissues around the washer (*P < 0.05, **P < 0.01, ***P < 0.001); (J) a schematic depicting the antibacterial properties of the proposed surface, which has release-killing, contact-killing, and trap-killing capabilities; and (K) illustration depicting potential antibacterial and antibiofilm strategies in a concurrent cell-bacteria system on the titanium surface.

Figure 9 (A) Schematic demonstration for Hep (heparin) immobilization on SR (silicone rubber) followed by NO (nitric oxide) donor SNAP (S-nitroso-N-acetyl penicillamine) impregnation by swelling, resulting in a heparinized NO-releasing surface; (B) S. aureus adhesion; and (C) platelet adhesion on unmodified SR, SR modified only with Hep, SR modified only with SNAP, and SR modified with Hep and SNAP; and (D) photograph display Hep–NO–SR catheter tubes after four hours in an extracorporeal circuit model showing minimal thrombogenesis.

Notes: #p < 0.05 vs SR. ^p < 0.05 vs Hep-SR. *p < 0.05 vs NO-SR. Negative (-) represents absence while positive (+) shows presence. Reprinted with permission from Devine R, Goudie MJ, Singha P et al. Mimicking the Endothelium: Dual Action Heparinized Nitric Oxide Releasing Surface. ACS Appl Mater Interfaces. 2020;12(18):20,158–20,171. Copyright © 2020 American Chemical Society.Citation70
Figure 9 (A) Schematic demonstration for Hep (heparin) immobilization on SR (silicone rubber) followed by NO (nitric oxide) donor SNAP (S-nitroso-N-acetyl penicillamine) impregnation by swelling, resulting in a heparinized NO-releasing surface; (B) S. aureus adhesion; and (C) platelet adhesion on unmodified SR, SR modified only with Hep, SR modified only with SNAP, and SR modified with Hep and SNAP; and (D) photograph display Hep–NO–SR catheter tubes after four hours in an extracorporeal circuit model showing minimal thrombogenesis.

Figure 10 (A) Schematic presentation for the synthesis of PCBDA@AgNPs; (B) PCBDA@AgNPs immobilization on amino-modified cotton gauze; and (C) in vivo wound healing with the PCBDA@AgNPs-CG dressing.

Notes: Reprinted from Chem Eng J, 409, Xiang J, Zhu R, Lang S, Yan H, Liu G, Peng B, Mussel-inspired immobilization of zwitterionic silver nanoparticles toward antibacterial cotton gauze for promoting wound healing, 128,291, Copyright © 2021, with permission from Elsevier.Citation145
Figure 10 (A) Schematic presentation for the synthesis of PCBDA@AgNPs; (B) PCBDA@AgNPs immobilization on amino-modified cotton gauze; and (C) in vivo wound healing with the PCBDA@AgNPs-CG dressing.

Figure 11 (A) antibacterial and antiadhesion modes of action of the contact killing strategy presented by coated non-releasable bactericidal molecules on the Titanium implant surface. Here APTES is (3-aminopropyl) triethoxysilane. Schematic presentation of antibacterial and antiadhesion performances of (B) bare dental appliance and coated with (C) polyethylene glycol (PEG) and (D) a combination of chitosan (cs) and PEG.

Notes: (A) Reprinted from Acta Biomater, 114, Shen J, Gao P, Han S, et al, A tailored positively-charged hydrophobic surface reduces the risk of implant associated infections, 421–430, Copyright © 2020, with permission from Elsevier.Citation166 (B-D) Reprinted with permission from Peng L, Chang L, Si M et al. Hydrogel-Coated Dental Device with Adhesion-Inhibiting and Colony-Suppressing Properties. ACS Appl Mater Interfaces. 2020;12(8):9718–9725. Copyright © 2020 American Chemical Society.Citation168
Figure 11 (A) antibacterial and antiadhesion modes of action of the contact killing strategy presented by coated non-releasable bactericidal molecules on the Titanium implant surface. Here APTES is (3-aminopropyl) triethoxysilane. Schematic presentation of antibacterial and antiadhesion performances of (B) bare dental appliance and coated with (C) polyethylene glycol (PEG) and (D) a combination of chitosan (cs) and PEG.

Figure 12 (A) A schematic representation of the antibacterial and antibiofouling properties of silicone rubber tubes (a commonly used catheter material) coated with copolymers; rat implanted with (B and C) pristine PDMS (left) and g-PEG45-b-AMP coated PDMS (right) at 0 and 5th day, respectively; (D and E) rat images after implants removal for antiadhesion test against bacterial adhesion at 5th day; (F) Log CFU/implant; (G) representative colonies images of E. coli isolated from both implants; and (H) SEM images of adhered bacteria on both implants. (I) schematic presentation for the molecular structure and effects of PU-DMH; (J) schematic demonstration for the antibacterial performance evaluation under flow conditions; (K) confocal laser scanning microscopic images after circulating experiment; and (L) S. aureus density on PU and PU-DMH surfaces.

Notes: Here PDMS is polydimethylsiloxane, and CFU is colony-forming units. (A-H) Reprinted from Acta Biomater, 51, Gao Q, Yu M, Su Y, et al, Rationally designed dual functional block copolymers for bottlebrush-like coatings: In vitro and in vivo antimicrobial, antibiofilm, and antifouling properties, 112–124, Copyright 2017, with permission from Elsevier.Citation170 (I-L) Reprinted with permission from Zhang X-Y, Zhao Y-Q, Zhang Y et al. Antimicrobial Peptide-Conjugated Hierarchical Antifouling Polymer Brushes for Functionalized Catheter Surfaces. Biomacromolecules. 2019;20(11):4171–4179. Copyright © 2020 American Chemical Society.Citation172
Figure 12 (A) A schematic representation of the antibacterial and antibiofouling properties of silicone rubber tubes (a commonly used catheter material) coated with copolymers; rat implanted with (B and C) pristine PDMS (left) and g-PEG45-b-AMP coated PDMS (right) at 0 and 5th day, respectively; (D and E) rat images after implants removal for antiadhesion test against bacterial adhesion at 5th day; (F) Log CFU/implant; (G) representative colonies images of E. coli isolated from both implants; and (H) SEM images of adhered bacteria on both implants. (I) schematic presentation for the molecular structure and effects of PU-DMH; (J) schematic demonstration for the antibacterial performance evaluation under flow conditions; (K) confocal laser scanning microscopic images after circulating experiment; and (L) S. aureus density on PU and PU-DMH surfaces.

Figure 13 (A) Schematic illustration for the synthesis of zwitterionic antimicrobial Cu metal-phenolic network and coating of contact lens; (B) antibacterial and antifouling mechanism; (C) antiadhesion; (D) antibacterial; and (E) antibiofouling propensities. Reproduced with permission.Citation173 (F) schematic presentation for the medical-grade titanium surface coated with (3-aminopropyl) triethoxysilane. Reproduced with permission.Citation166

Notes: (A-E) Reprinted with permission from Liu G, Li K, Wang H, Ma L, Yu L, Nie Y. Stable Fabrication of Zwitterionic Coating Based on Copper-Phenolic Networks on Contact Lens with Improved Surface Wettability and Broad-Spectrum Antimicrobial Activity. ACS Appl Mater Interfaces. 2020;12(14):16,125–16,136. Copyright © 2020 American Chemical Society.Citation173 (F) Reprinted from Acta Biomater, 114, Shen J, Gao P, Han S, et al, A tailored positively-charged hydrophobic surface reduces the risk of implant associated infections, 421–430, Copyright © 2020, with permission from Elsevier.Citation166
Figure 13 (A) Schematic illustration for the synthesis of zwitterionic antimicrobial Cu metal-phenolic network and coating of contact lens; (B) antibacterial and antifouling mechanism; (C) antiadhesion; (D) antibacterial; and (E) antibiofouling propensities. Reproduced with permission.Citation173 (F) schematic presentation for the medical-grade titanium surface coated with (3-aminopropyl) triethoxysilane. Reproduced with permission.Citation166

Figure 14 (A) Interaction of co-existing non-releasable bactericidal and fouling repelling moieties with microbials on biomaterial surface; (B) Interaction of co-existing non-releasable bactericidal and fouling releasing moieties with microbials on biomaterial surface; and (C) Interaction of co-existing non-releasable bactericidal and fouling repelling moieties with microbials on the surfaces of biomaterials and biomedical devices.

Note: Created with BioRender.com.
Figure 14 (A) Interaction of co-existing non-releasable bactericidal and fouling repelling moieties with microbials on biomaterial surface; (B) Interaction of co-existing non-releasable bactericidal and fouling releasing moieties with microbials on biomaterial surface; and (C) Interaction of co-existing non-releasable bactericidal and fouling repelling moieties with microbials on the surfaces of biomaterials and biomedical devices.