Anti-infective Surface Coatings: Design and Therapeutic Promise against Device-Associated Infections

Biomimetic Nanopillar Silicon Surfaces Rupture Fungal Spores

The mechano-bactericidal action of nanostructured surfaces is well-documented; however, synthetic nanostructured surfaces have not yet been explored for their antifungal properties toward filamentous fungal species. In this study, we developed a biomimetic nanostructured surface inspired by dragonfly wings. A high-aspect-ratio nanopillar topography was created on silicon (nano-Si) surfaces using inductively coupled plasma reactive ion etching (ICP RIE). To mimic the superhydrophobic nature of insect wings, the nano-Si was further functionalised with trichloro(1H,1H,2H,2H-perfluorooctyl)silane (PFTS). The viability of Aspergillus brasiliensis spores, in contact with either hydrophobic or hydrophilic nano-Si surfaces, was determined using a combination of standard microbiological assays, confocal laser scanning microscopy (CLSM), and focused ion beam scanning electron microscopy (FIB-SEM). Results indicated the breakdown of the fungal spore membrane upon contact with the hydrophilic nano-Si surfaces. By contrast, hydrophobised nano-Si surfaces prevented the initial attachment of the fungal conidia. Hydrophilic nano-Si surfaces exhibited both antifungal and fungicidal properties toward attached A. brasisiensis spores via a 4-fold reduction of attached spores and approximately 9-fold reduction of viable conidia from initial solution after 24 h compared to their planar Si counterparts. Thus, we reveal, for the first time, the physical rupturing of attaching fungal spores by biomimetic hydrophilic nanostructured surfaces.

Rhamnolipid-Coated Iron Oxide Nanoparticles as a Novel Multitarget Candidate against Major Foodborne E. coli Serotypes and Methicillin-Resistant S. aureus

Surface-growing antibiotic-resistant pathogenic bacteria such as Escherichia coli and Staphylococcus aureus are emerging as a global health challenge due to dilemmas in clinical treatment. Furthermore, their pathogenesis, including increasingly serious antimicrobial resistance and biofilm formation, makes them challenging to treat by conventional therapy. Therefore, the development of novel antivirulence strategies will undoubtedly provide a path forward in combatting these resistant bacterial infections. In this regard, we developed novel biosurfactant-coated nanoparticles to combine the antiadhesive/antibiofilm properties of rhamnolipid (RHL)-coated Fe3O4 nanoparticles (NPs) with each of the p-coumaric acid (p-CoA) and gallic acid (GA) antimicrobial drugs by using the most available polymer common coatings (PVA) to expand the range of effective antibacterial drugs, as well as a mechanism for their synergistic effect via a simple method of preparation. Mechanistically, the average size of bare Fe3O4 NPs was ~15 nm, while RHL-coated Fe3O4@PVA@p-CoA/GA was about ~254 nm, with a drop in zeta potential from -18.7 mV to -34.3 mV, which helped increase stability. Our data show that RHL-Fe3O4@PVA@p-CoA/GA biosurfactant NPs can remarkably interfere with bacterial growth and significantly inhibited biofilm formation to more than 50% via downregulating IcaABCD and CsgBAC operons, which are responsible for slime layer formation and curli fimbriae production in S. aureus and E. coli, respectively. The novelty regarding the activity of RHL-Fe3O4@PVA@p-CoA/GA biosurfactant NPs reveals their potential effect as an alternative multitarget antivirulence candidate to minimize infection severity by inhibiting biofilm development. Therefore, they could be used in antibacterial coatings and wound dressings in the future. IMPORTANCE Antimicrobial resistance poses a great threat and challenge to humanity. Therefore, the search for alternative ways to target and eliminate microbes from plant, animal, and marine microorganisms is one of the world's concerns today. Furthermore, the extraordinary capacity of S. aureus and E. coli to resist standard antibacterial drugs is the dilemma of all currently used remedies. Methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) have become widespread, leading to no remedies being able to treat these threatening pathogens. The most widely recognized serotypes that cause severe foodborne illness are E. coli O157:H7, O26:H11, and O78:H10, and they display increasing antimicrobial resistance rates. Therefore, there is an urgent need for an effective therapy that has dual action to inhibit biofilm formation and decrease bacterial growth. In this study, the synthesized RHL-Fe3O4@PVA@p-CoA/GA biosurfactant NPs have interesting properties, making them excellent candidates for targeted drug delivery by inhibiting bacterial growth and downregulating biofilm-associated IcaABCD and CsgBAC gene loci.

Clonal Diversity and Epidemiological Characteristics of ST239-MRSA Strains

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen associated with severe morbidity and mortality and poses a significant threat to public health worldwide. The genetic diversity based on sequence types of MRSA strains was illustrated in previous studies; meanwhile, the diversity along with the predominant sequence type, especially in Egypt, remains unknown. The purpose of the current study was to determine the diversity of the predominant MRSA clone ST239-MRSA (n = 50) isolated from different hosts and clinical samples and to illustrate the correlation between the resistance patterns, toxin genes, and the genetic background in Port-said and El-Sharkia Governorates, Egypt. The ST239-MRSA clone was analyzed by phenotypic antibiotyping and various genotypic assays comprising SCCmec, agr, spa, coa, and coa-RFLP in addition to toxin gene profiles. Most of the analyzed strains (40/50, 80%) were multidrug resistant (MDR), belonged to SCCmec-III, agr-I, and coa genotype I, and harbored sea and pvl genes. A negative correlation between the toxin gene profiles and antimicrobial resistance was recorded. Meanwhile, the correlation between the toxin gene profiles and the genetic background was not observed in this study. Although ST239-MRSA strains belonged to a single sequence type, they exhibited a high degree of phenotypic and genotypic diversity, indicating weak clonality and adaptability. With such diversity, it is assumed that these strains may have undergone different evolutionary processes during transmission events among and/or within a single host or tissue niche.

Assessment of nonreleasing antifungal surface coatings bearing covalently attached pharmaceuticals

There are many reports of antimicrobial coatings bearing immobilized active agents on surfaces; however, strong analytical evidence is required to verify that the agents are indeed covalently attached to the surface. In the absence of such evidence, antimicrobial activity could result from a release of active agents. We report a detailed assessment of antifungal surface coatings prepared using covalent attachment chemistries, with the aim of establishing a set of instrumental and biological evidence required to convincingly demonstrate antimicrobial activity due to nonreleasing, surface active compounds and to exclude the alternate possibility of activity due to release. The strongest biological evidence initially supporting permanent antifungal activity was the demonstration of the ability to reuse samples in multiple, sequential pathogen challenges. However, additional supporting evidence from washing studies and instrumental analysis is also required to probe the possibility of gradual desorption of strongly physisorbed compounds versus covalently attached compounds. Potent antifungal surface coatings were prepared from approved pharmaceutical compounds from the echinocandin drug class (caspofungin, anidulafungin, and micafungin) and assessed by microbiological tests and instrumental methods. Carbonyl diimidazole linking chemistry enabled covalent attachment of caspofungin, anidulafungin, and micafungin to plasma polymer surfaces, with antifungal surface activity likely caused by molecular orientations that present the lipophilic tail toward interfacing fungal cells. This study demonstrates the instrumental and biological evidence required to convincingly ascertain activity due to nonreleasing, surface active compounds and summarize these as three criteria for assessing other reports on surface-immobilized antimicrobial compounds.

Candida albicans Can Survive Antifungal Surface Coatings on Surfaces with Microcone Topography

This study demonstrates the ability of Candida albicans, a medically significant human fungal pathogen, to minimize contact with an antifungal surface coating that on a flat surface is lethal on contact by growing on and between micron-sized surface topographical features, thus minimizing the contact area. Scanning electron microscopy showed that cells contacting the "floor" between microcones were killed, whereas cells attached to microcones survived and formed hyphal filaments. These spanned space between cones and avoided contact with the flat surface in-between cones. Thus, fungal cells managed to attach and grow despite the antifungal coating. This ability of Candida albicans to exploit topography features to minimize surface contact yet utilize the solid surface for anchoring reduces the effectiveness of the grafted antifungal surface coating. This suggests that biomedical devices with rough surfaces might be more challenging to protect against fungal biofilm formation via application of an antifungal coating.

Development of Novel Amphotericin B-Immobilized Nitric Oxide-Releasing Platform for the Prevention of Broad-Spectrum Infections and Thrombosis

Indwelling medical devices currently used to diagnose, monitor, and treat patients invariably suffer from two common clinical complications: broad-spectrum infections and device-induced thrombosis. Currently, infections are managed through antibiotic or antifungal treatment, but the emergence of antibiotic resistance, the formation of recalcitrant biofilms, and difficulty identifying culprit pathogens have made treatment increasingly challenging. Additionally, systemic anticoagulation has been used to manage device-induced thrombosis, but subsequent life-threatening bleeding events associated with all available therapies necessitates alternative solutions. In this study, a broad-spectrum antimicrobial, antithrombotic surface combining the incorporation of the nitric oxide (NO) donor S-nitroso-N-acetylpenicillamine (SNAP) with the immobilization of the antifungal Amphotericin B (AmB) on polydimethylsiloxane (PDMS) was developed in a two-step process. This novel strategy combines the key advantages of NO, a bactericidal agent and platelet inhibitor, with AmB, a potent antifungal agent. We demonstrated that SNAP-AmB surfaces significantly reduced the viability of adhered Staphylococcus aureus (99.0 ± 0.2%), Escherichia coli (89.7 ± 1.0%), and Candida albicans (93.5 ± 4.2%) compared to controls after 24 h of in vitro exposure. Moreover, SNAP-AmB surfaces reduced the number of platelets adhered by 74.6 ± 3.9% compared to controls after 2 h of in vitro porcine plasma exposure. Finally, a cytotoxicity assay validated that the materials did not present any cytotoxic side effects toward human fibroblast cells. This novel approach is the first to combine antifungal surface functionalization with NO-releasing technology, providing a promising step toward reducing the rate of broad-spectrum infection and thrombosis associated with indwelling medical devices.

Based on the synergistic effect of Mg2+ and antibacterial peptides to improve the corrosion resistance, antibacterial ability and osteogenic activity of magnesium-based degradable metals

To overcome the restricted degradation, poor antiacterial and osteoindctive problems of magnesium and its alloys, this study presented the spinning coating of an antimicrobial peptide (AP)-loaded silk fibroin (SF) composite onto a corrosion-resistant MgO-coated AZ31 Mg alloy via anodization (aMgO) and electrodeposition (eMgO) methods. The composite coatings not only created a smooth and hydrophilic surface, but also obviously improved the corrosion resistance according to the test of corrosion potential and current density. The colonization of E. coli on MgO-AP composite coatings was significantly reduced as compared to the MgO layers, due to the potential synergetic effects of APs and Mg2+. Compared with the bare AZ31, the composite coating inhibited the corrosion of the substrate and the release of Mg2+, supported the adhesion, spreading and proliferation of osteoblasts, and presented a significantly improved osteogenic differentiation trend. Therefore, the MgO-AP composite coating, which had both antibacterial and bone-promoting abilities, was expected to be applied for surface modification of magnesium alloy implants to solve the clinical problems of bacterial infection and poor osseointegration.

Tailoring the immobilization and release of chlorhexidine using dopamine chemistry to fight infections associated to orthopedic devices

A crucial factor in the pathogenesis of orthopedics associated infections is that bacteria do not only colonize the implant surface but also the surrounding tissues. This study aimed to engineer an antimicrobial release coating for stainless steel (SS) surfaces, to impart them with the ability to prevent Staphylococci colonization. Chlorhexidine (CHX) was immobilized using two polydopamine (pDA)-based approaches: a one-pot synthesis, where CHX is dissolved together with dopamine before its polymerization; and a two-step methodology, comprising the deposition of a pDA layer to which CHX is immobilized. To modulate CHX release, an additional layer of pDA was also added for both strategies. Immobilization of CHX using a one-step approach yielded surfaces with a more homogenous coating and less roughness than the other strategies. The amount of released CHX was lower for the one-step approach, as opposed to the two-step approach yielding the higher release, which could be decreased by applying an outward layer of pDA. Both one and two-step approaches provided the surfaces with the ability to prevent bacterial colonization of the surface itself and kill most of bacteria in the bulk phase up to 10 days. This long-term antimicrobial performance alluded a stable and enduring immobilization of CHX. In terms of biocompatibility, the amount of CHX released from the one-step approach did not compromise the growth of mammalian cells, contrary to the two-step strategy. Additionally, the few bacteria that managed to adhere to surfaces modified with one-step approach did not show evidence of resistance towards CHX. Overall data underline that one-step immobilization of CHX holds great potential to be further applied in the fight against orthopedic devices associated infections.

Polymeric antibiofilm coating comprising synergistic combination of citral and thymol prevents methicillin-resistant Staphylococcus aureus biofilm formation on titanium

Biomaterial associated microbial infections are complicated and mostly lead to revision surgery or removal which are painful to the patients and quite expensive. These infections are difficult to treat with antibiotics as it is often related to biofilm formation. Methicillin resistant Staphylococcus aureus (MRSA) is the leading pathogen in biomaterial associated infections and well known to form biofilm on foreign materials. To reduce the risk of biomaterial associated infections, recent treatment strategies focus on modification of the implant surface to prevent the adhesion of bacteria. Antibiofilm coating is the effective approach than coating with antimicrobials as antibiofilm agents will not create selective pressure thereby excludes possibility of drug resistance. The current study identified and validated the synergistic antibiofilm activity of citral (CIT) and thymol (THY) by crystal violet quantification and microscopic analysis without alteration in growth and metabolic viability of MRSA. Polymeric antibiofilm coating with CIT + THY as active ingredients was formulated and coated on titanium surface by the process of spin coating. Fourier-transform infrared spectroscopy (FTIR) analysis confirmed the effective blending of polymeric formulation and the presence of CIT and THY. Atomic force microscopy (AFM) images revealed the homogenous coating and reduced surface roughness and thickness of the coating was measured by surface profilometer. Antibiofilm coating released CIT and THY in a sustained manner for 60 days. Antibiofilm coating effectively inhibited MRSA adherence in vitro and antibiofilm activity of coating was not affected by plasma conditioning. In addition, antibiofilm coating was non-hemolytic and non-toxic to PBMC. Thus, the current study demonstrated the effectual strategy to prevent biomaterial associated infections and proposes the prospective role of antibiofilm coating in clinical applications.

Graphene: An Antibacterial Agent or a Promoter of Bacterial Proliferation?

Graphene materials (GMs) are being investigated for multiple microbiological applications because of their unique physicochemical characteristics including high electrical conductivity, large specific surface area, and robust mechanical strength. In the last decade, studies on the interaction of GMs with bacterial cells appear conflicting. On one side, GMs have been developed to promote the proliferation of electroactive bacteria on the surface of electrodes in bioelectrochemical systems or to accelerate interspecies electron transfer during anaerobic digestion. On the other side, GMs with antibacterial properties have been synthesized to prevent biofilm formation on membranes for water treatment, on medical equipment, and on tissue engineering scaffolds. In this review, we discuss the mechanisms and factors determining the positive or negative impact of GMs on bacteria. Furthermore, we examine the bacterial growth-promoting and antibacterial applications of GMs and debate their practicability.

Graphene: An Antibacterial Agent or a Promoter of Bacterial Proliferation?

Graphene materials (GMs) are being investigated for multiple microbiological applications because of their unique physicochemical characteristics including high electrical conductivity, large specific surface area, and robust mechanical strength. In the last decade, studies on the interaction of GMs with bacterial cells appear conflicting. On one side, GMs have been developed to promote the proliferation of electroactive bacteria on the surface of electrodes in bioelectrochemical systems or to accelerate interspecies electron transfer during anaerobic digestion. On the other side, GMs with antibacterial properties have been synthesized to prevent biofilm formation on membranes for water treatment, on medical equipment, and on tissue engineering scaffolds. In this review, we discuss the mechanisms and factors determining the positive or negative impact of GMs on bacteria. Furthermore, we examine the bacterial growth-promoting and antibacterial applications of GMs and debate their practicability.

Polyphosphazenes enable durable, hemocompatible, highly efficient antibacterial coatings

Biocompatible antibacterial coatings are highly desirable to prevent bacterial colonization on a wide range of medical devices from hip implants to skin grafts. Traditional polyelectrolytes are unable to directly form coatings with cationic antibiotics at neutral pH and suffer from high degrees of antibiotic release upon exposure to physiological concentrations of salt. Here, novel inorganic-organic hybrid polymer coatings based on direct layer-by-layer assembly of anionic polyphosphazenes (PPzs) of various degrees of fluorination with cationic antibiotics (polymyxin B, colistin, gentamicin, and neomycin) are reported. The coatings displayed low levels of antibiotic release upon exposure to salt and pH-triggered response of controlled doses of antibiotics. Importantly, coatings remained highly surface active against Escherichia coli and Staphylococcus aureus, even after 30 days of pre-exposure to physiological conditions (bacteria-free) or after repeated bacterial challenge. Moreover, coatings displayed low (<1%) hemolytic activity for both rabbit and porcine blood. Coatings deposited on either hard (Si wafers) or soft (electrospun fiber matrices) materials were non-toxic towards fibroblasts (NIH/3T3) and displayed controllable fibroblast adhesion via PPz fluorination degree. Finally, coatings showed excellent antibacterial activity in ex vivo pig skin studies. Taken together, these results suggest a new avenue to form highly tunable, biocompatible polymer coatings for medical device surfaces.

Chitosan coated catheters alleviates mixed species biofilms of Staphylococcus epidermidis and Candida albicans

Microorganisms which adhere to the surfaces of indwelling medical implants develop into a sessile microbial community to form monomicrobial or polymicrobial biofilms. Staphylococcus epidermidis and Candida albicans are the most common pathogens co-isolated from device mediated infections. Hence development of catheters coated with anti-fouling substances is of great interest. In this current study, chitosan, extracted from the shells of marine crab Portunus sanguinolentus was coated over the surface of the urinary catheters and checked for its efficacy to inhibit the adherence of both mono and mixed species biofilms. The Extracted Chitosan (EC) coated catheters showed profound activity in reducing the preformed biofilms and the other virulence factors of the pathogens like slime production in S. epidermidis and yeast to hyphal swtich in C. albicans. Furthermore, qPCR analysis showed that EC could downregulate the virulence genes in both the pathogens when grown as monospecies and mixed species biofilms.

Advances in Biomaterials for the Prevention and Disruption of Candida Biofilms

Candida species can readily colonize a multitude of indwelling devices, leading to biofilm formation. These three-dimensional, surface-associated Candida communities employ a multitude of sophisticated mechanisms to evade treatment, leading to persistent and recurrent infections with high mortality rates. Further complicating matters, the current arsenal of antifungal therapeutics that are effective against biofilms is extremely limited. Antifungal biomaterials are gaining interest as an effective strategy for combating Candida biofilm infections. In this review, we explore biomaterials developed to prevent Candida biofilm formation and those that treat existing biofilms. Surface functionalization of devices employing clinically utilized antifungals, other antifungal molecules, and antifungal polymers has been extremely effective at preventing fungi attachment, which is the first step of biofilm formation. Several mechanisms can lead to this attachment inhibition, including contact killing and release-based killing of surrounding planktonic cells. Eliminating mature biofilms is arguably much more difficult than prevention. Nanoparticles have shown the most promise in disrupting existing biofilms, with the potential to penetrate the dense fungal biofilm matrix and locally target fungal cells. We will describe recent advances in both surface functionalization and nanoparticle therapeutics for the treatment of Candida biofilms.

A Biodegradable Antifungal-Loaded Sol-Gel Coating for the Prevention and Local Treatment of Yeast Prosthetic-Joint Infections

Fungal prosthetic-joint infections are rare but devastating complications following arthroplasty. These infections are highly recurrent and expose the patient to the development of candidemia, which has high mortality rates. Patients with this condition are often immunocompromised and present several comorbidities, and thus pose a challenge for diagnosis and treatment. The most frequently isolated organisms in these infections are Candida albicans and Candida parapsilosis, pathogens that initiate the infection by developing a biofilm on the implant surface. In this study, a novel hybrid organo-inorganic sol-gel coating was developed from a mixture of organopolysiloxanes and organophosphite, to which different concentrations of fluconazole or anidulafungin were added. Then, the capacity of these coatings to prevent biofilm formation and treat mature biofilms produced by reference and clinical strains of C. albicans and C. Parapsilosis was evaluated. Anidulafungin-loaded sol-gel coatings were more effective in preventing C. albicans biofilm formation, while fluconazole-loaded sol-gel prevented C. parapsilosis biofilm formation more effectively. Treatment with unloaded sol-gel was sufficient to reduce C. albicans biofilms, and the sol-gels loaded with fluconazole or anidulafungin slightly enhanced this effect. In contrast, unloaded coatings stimulated C. parapsilosis biofilm formation, and loading with fluconazole reduced these biofilms by up to 99%. In conclusion, these coatings represent a novel therapeutic approach with potential clinical use to prevent and treat fungal prosthetic-joint infections.

Multifunctional Properties of Quercitrin-Coated Porous Ti-6Al-4V Implants for Orthopaedic Applications Assessed In Vitro

(1) One strategy to improve the outcome of orthopedic implants is to use porous implants with the addition of a coating with an antibacterial biomolecule. In this study, we aimed to produce and test the biocompatibility, the osteopromotive (both under normal conditions and under a bacterial challenge with lipopolysaccharide (LPS)) and antibacterial activities of a porous Ti-6Al-4V implant coated with the flavonoid quercitrin in vitro. (2) Porous Ti-6Al-4V implants were produced by 3D printing and further functionalized with quercitrin by wet chemistry. Implants were characterized in terms of porosity and mechanical testing, and the coating with quercitrin by fluorescence staining. Implant biocompatibility and bioactivity was tested using MC3T3-E1 preosteoblasts by analyzing cytotoxicity, cell adhesion, osteocalcin production, and alkaline phosphatase (ALP) activity under control and under bacterial challenging conditions using lipopolysaccharide (LPS). Finally, the antibacterial properties of the implants were studied using Staphylococcus epidermidis by measuring bacterial viability and adhesion. (3) Porous implants showed pore size of about 500 µm and a porosity of 52%. The coating was homogeneous over all the 3D surface and did not alter the mechanical properties of the Young modulus. Quercitrin-coated implants showed higher biocompatibility, cell adhesion, and osteocalcin production compared with control implants. Moreover, higher ALP activity was observed for the quercitrin group under both normal and bacterial challenging conditions. Finally, S. epidermidis live/dead ratio and adhesion after 4 h of incubation was lower on quercitrin implants compared with the control. (4) Quercitrin-functionalized porous Ti-6Al-4V implants present a great potential as an orthopedic porous implant that decreases bacterial adhesion and viability while promoting bone cell growth and differentiation.

Tailored Functional Surfaces Using Nanoparticle and Protein "Nanobrick" Coatings

Surface properties are an essential feature in a wide range of functional materials. In this article, we summarize strategies developed in our group that employ nanoparticles and proteins as nanobricks to create thin-film coatings on surfaces. These coatings contain tailorable surface functionality based on the properties of the predesigned nanobricks, parlaying both the chemical and structural features of the precursor particles and proteins. This strategy is versatile, providing the rapid generation of both uniform and patterned coatings that provide "plug-and-play" customizable surfaces for materials and biomedical applications.

Biosurfactant coated silver and iron oxide nanoparticles with enhanced anti-biofilm and anti-adhesive properties

Pseudomonas aeruginosa and Staphylococcus aureus are among the hazardous biofilm forming bacteria ubiquitous in industrial/clinical wastes. Serious efforts are required to develop effective strategies to control surface-growing antibiotic resistant pathogenic bacterial communities which they are emerging as a global health issue. Blocking hazardous biofilms would be a useful aspect of biosurfactant coated nanoparticles (NPs). In this regard, we report a facile method for the synthesis of rhamnolipid (RL) coated silver (Ag) and iron oxide (Fe₃O₄) NPs and propose the mechanism of their synergistic antibacterial and anti-adhesive properties against biofilms formed by P. aeruginosa and S. aureus. These NPs demonstrated excellent anti-biofilm activity not only during the biofilms formation but also on the pre-formed biofilms. Mechanistically, RL coated silver (35 nm) and Fe₃O₄ NPs (48 nm) generate reactive oxygen species, which contribute to the antimicrobial activity. The presence of RLs shell on the nanoparticles significantly reduces the cell adhesion by modifying the surface hydrophobicity and hence enhancing the anti-biofilm property of NPs against both mentioned strains. These findings suggest that RL coated Ag and Fe₃O₄ NPs may be used as potent alternate to reduce the infection severity by inhibiting the biofilm formation and, therefore, they possess potential biomedical applications for antibacterial coatings and wound dressings.

Surface-grafted antimicrobial drugs: Possible misinterpretation of mechanism of action

Antimicrobial surface coatings that act through a contact-killing mechanism (not diffusive release) could offer many advantages to the design of medical device coatings that prevent microbial colonization and infections. However, as the authors show here, to prevent arriving at an incorrect conclusion about their mechanism of action, it is essential to employ thorough washing protocols validated by surface analytical data. Antimicrobial surface coatings were fabricated by covalently attaching polyene antifungal drugs to surface coatings. Thorough washing (often considered to be sufficient to remove noncovalently attached molecules) was used after immobilization and produced samples that showed a strong antifungal effect, with a log 6 reduction in Candida albicans colony forming units. However, when an additional washing step using surfactants and warmed solutions was used, more firmly adsorbed compounds were eluted from the surface as evidenced by XPS and ToF-SIMS, resulting in reduction and complete elimination of in vitro antifungal activity. Thus, polyene molecules covalently attached to surfaces appear not to have a contact-killing effect, probably because they fail to reach their membrane target. Without additional stringent washing and surface analysis, the initial favorable antimicrobial testing results could have been misinterpreted as evidencing activity of covalently grafted polyenes, while in reality activity arose from desorbing physisorbed molecules. To avoid unintentional confirmation bias, they suggest that binding and washing protocols be analytically verified by qualitative/quantitative instrumental methods, rather than relying on false assumptions of the rigors of washing/soaking protocols.

Polyaspartamide Functionalized Catechol-Based Hydrogels Embedded with Silver Nanoparticles for Antimicrobial Properties

In this study, polyaspartamide-based hydrogels were synthesized by boron-catechol coordination followed by incorporation of AgNPs into the materials. Free catechol moieties were exploited to produce AgNPs. TEM analyses displayed AgNPs of less than 20 nm in diameter and with minimum aggregation, attesting the role of hydrogels to act as an efficient template for the production of dispersed particles. XRD analyses confirmed the mean particle size using the Scherrer equation. Release kinetic studies were performed in DMEM medium, showing a slow release over a long time-period. Finally, the MIC and MBC were determined, demonstrating a bacteriostatic and bactericidal effect against Gram-positive S. aureus and Gram-negative E. coli.

Nanocomposites: suitable alternatives as antimicrobial agents

The exploration of nanocomposites has gained a strong research following over the last decade. These materials have been heavily exploited in several fields, with applications ranging from biosensors to biomedicine. Among these applications, great advances have been made in the field of microbiology, specifically as antimicrobial agents. This review aims to provide a comprehensive account of various nanocomposites that elucidate promising antimicrobial activity. The composition, physical and chemical properties, as well as the antimicrobial performance of these nanocomposites, are discussed in detail.

Polynitroxide copolymers to reduce biofilm fouling on surfaces

Polynitroxide films – the first example of surface tethered nitroxides reducing biofilm fouling.

The importance of fungal pathogens and antifungal coatings in medical device infections

In recent years, increasing evidence has been collated on the contributions of fungal species, particularly Candida, to medical device infections. Fungal species can form biofilms by themselves or by participating in polymicrobial biofilms with bacteria. Thus, there is a clear need for effective preventative measures, such as thin coatings that can be applied onto medical devices to stop the attachment, proliferation, and formation of device-associated biofilms. However, fungi being eukaryotes, the challenge is greater than for bacterial infections because antifungal agents are often toxic towards eukaryotic host cells. Whilst there is extensive literature on antibacterial coatings, a far lesser body of literature exists on surfaces or coatings that prevent attachment and biofilm formation on medical devices by fungal pathogens. Here we review strategies for the design and fabrication of medical devices with antifungal surfaces. We also survey the microbiology literature on fundamental mechanisms by which fungi attach and spread on natural and synthetic surfaces. Research in this field requires close collaboration between biomaterials scientists, microbiologists and clinicians; we consider progress in the molecular understanding of fungal recognition of, and attachment to, suitable surfaces, and of ensuing metabolic changes, to be essential for designing rational approaches towards effective antifungal coatings, rather than empirical trial of coatings.

Anti-Adherent Biomaterials for Prevention of Catheter Biofouling

Medical device-associated infections present a leading global healthcare challenge, and effective strategies to prevent infections are urgently required. Herein, we present an innovative anti-adherent hydrogel copolymer as a candidate catheter coating with complementary hydrophobic drug-carrying and eluting capacities. The amphiphilic block copolymer, Poloxamer 188, was chemically-derivatized with methacryloyl moieties and copolymerized with the hydrogel monomer, 2-hydroxyethyl methacrylate. Performance of the synthesized copolymers was evaluated in terms of equilibrium swelling, surface water wettability, mechanical integrity, resistance to encrustation and bacterial adherence, and ability to control release of the loaded fluoroquinolone antibiotic, ofloxacin. The developed matrices were able to provide significant protection from fouling, with observed reductions of over 90% in both adherence of the common urinary pathogen Escherichia coli and encrusting crystalline deposits of calcium and magnesium salts relative to the commonly employed hydrogel, poly (hydroxyethyl methacrylate). Additionally, the release kinetics of a loaded hydrophobic drug could be readily tuned through facile manipulation of polymer composition. This combinatorial approach shows significant promise in the development of suitable systems for prevention of catheter-associated infections.

Surface modification of valve metals using plasma electrolytic oxidation for antibacterial applications: A review

Plasma electrolytic oxidation (PEO) is an advance technique to develop porous oxidation layer on light metals, primarily to enhance corrosion and wear resistance. The oxidation layer can also offer a wide variety of mechanical, biomedical, tribological, and antibacterial properties through the incorporation of several ions and particles. Due to the increasing need of antimicrobial surfaces for biomedical implants, antibacterial PEO coatings have been developed through the incorporation of antibacterial agents. Metallic nanoparticles that have been employed most widely as antibacterial agents are reported to demonstrate serious health and environmental threats. To overcome the current limitations of these coatings, there is a significant need to develop antibacterial surfaces that are not harmful for patient's health and environment. Attention of the readers has been directed to utilize bioactive glasses as antibacterial agents for PEO coatings. Bioactive glasses are well known for their excellent bioactivity, biocompatibility, and antibacterial character. PEO coatings incorporated with bioactive glasses can provide environment-friendly antimicrobial surfaces with exceptional bioactivity, biocompatibility, and osseointegration. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 590-605, 2018.

Alternating Current Electrophoretic Deposition for the Immobilization of Antimicrobial Agents on Titanium Implant Surfaces

One prominent cause of implant failure is infection; therefore, research is focusing on developing surface coatings that render the surface resistant to colonization by micro-organisms. Permanently attached coatings of antimicrobial molecules are of particular interest because of the reduced cytoxicity and lower risk of developing resistance compared to controlled release coatings. In this study, we focus on the chemical grafting of bioactive molecules on titanium. To concentrate the molecules at the metallic implant surface, we propose electrophoretic deposition (EPD) applying alternating current (AC) signals with an asymmetrical wave shape. We show that for the model molecule bovine serum albumin (BSA), as well as for the clinically relevant antifungal lipopeptide caspofungin (CASP), the deposition yield is drastically improved by superimposing a DC offset in the direction of the high-amplitude peak of the AC signal. Additionally, in order to produce immobilized CASP coatings, this experimental AC/DC-EPD method is combined with an established surface activation protocol. Principle component analysis (PCA) of time-of-flight secondary ion mass spectrometry (ToF-SIMS) data confirm the immobilization of CASP with higher yield as compared to a diffusion-controlled process, and higher purity than the clinical CASP starting suspensions. Scratch testing data indicate good coating adhesion. Importantly, the coatings remain active against the fungal pathogen C. albicans as shown by in vitro biofilm experiments. In summary, this paper delivers a proof-of-concept for the application of AC-EPD as a fast grafting tool for antimicrobial molecules without compromising their activities.

Probiotic E. coli Nissle 1917 biofilms on silicone substrates for bacterial interference against pathogen colonization

Bacterial interference is an alternative strategy to fight against device-associated bacterial infections. Pursuing this strategy, a non-pathogenic bacterial biofilm is used as a live, protective barrier to fence off pathogen colonization. In this work, biofilms formed by probiotic Escherichia coli strain Nissle 1917 (EcN) are investigated for their potential for long-term bacterial interference against infections associated with silicone-based urinary catheters and indwelling catheters used in the digestive system, such as feeding tubes and voice prostheses. We have shown that EcN can form stable biofilms on silicone substrates, particularly those modified with a biphenyl mannoside derivative. These biofilms greatly reduced the colonization by pathogenic Enterococcus faecalis in Lysogeny broth (LB) for 11days.

STATEMENT OF SIGNIFICANCE

Bacterial interference is an alternative strategy to fight against device-associated bacterial infections. Pursuing this strategy, we use non-pathogenic bacteria to form a biofilm that serves as a live, protective barrier against pathogen colonization. Herein, we report the first use of preformed probiotic E. coli Nissle 1917 biofilms on the mannoside-presenting silicone substrates to prevent pathogen colonization. The biofilms serve as a live, protective barrier to fence off the pathogens, whereas current antimicrobial/antifouling coatings are subjected to gradual coverage by the biomass from the rapidly growing pathogens in a high-nutrient environment. It should be noted that E. coli Nissle 1917 is commercially available and has been used in many clinical trials. We also demonstrated that this probiotic strain performed significantly better than the non-commercial, genetically modified E. coli strain that we previously reported.

Facile single-step bioconjugation of the antifungal agent caspofungin onto material surfaces via an epoxide plasma polymer interlayer

We report a facile, one-step, aqueous surface bioconjugation approach for producing an antifungal surface coating that prevents the formation of fungal biofilms.

Polymicrobial infections involving clinically relevant Gram-negative bacteria and fungi

Interactions between fungi and bacteria and their relevance to human health and disease have recently attracted increased attention in biomedical fields. Emerging evidence shows that bacteria and fungi can have synergistic or antagonistic interactions, each with important implications for human colonization and disease. It is now appreciated that some of these interactions may be strategic and helps promote the survival of one or both microorganisms within the host. This review will shed light on clinically relevant interactions between fungi and Gram-negative bacteria. Mechanism of interaction, host immune responses, and preventive measures will also be reviewed.