Anti-infective surface coatings: design and therapeutic promise against device-associated infections

Abstract

Patient safety and well-being are under increasing threat from hospital-acquired infections [1]. The root cause of a large number of these infections arises from microbial biofilms that colonise on surfaces of medical devices such as the millions of catheters, endotracheal tubes, and prosthetics implanted every year [2]. Biofilm infections are accompanied by increased resistance to antimicrobial therapy and immune clearance, severely limiting treatment options and leading to life-threatening disease [3,4]. Device-associated infections are caused by both bacteria and fungi and, while most studies have focused on single-species biofilms, biofilm-related infections are often polymicrobial [5–8]. Multi-species biofilms, particularly those involving bacterial and fungal pathogens, are more challenging to treat, likely as a consequence of their combined architecture, protective extracellular matrix, and potential synergism in protecting against antimicrobials and host immunity [9–11]. Among the fungi, Candida species are the most important biofilm pathogens [12,13] and the fourth leading cause of blood-stream infections in United States hospitals [7]. Fungal diseases remain difficult to diagnose, mortality rates remain high, and antifungal drug resistance continues to limit therapeutic options [14,15]. We are in desperate need of innovative strategies that target the mechanisms of pathogenesis of polymicrobial biofilms on medical devices. This is a grand challenge because it requires multidisciplinary collaboration and breakthrough research involving physical chemistry, materials science, and microbiology. Communication between these disciplines has not been common, but recent advances show greater convergence in the development of anti-infective devices. At this nexus, we outline the therapeutic promise of anti-infective coatings for medical devices and discuss pitfalls and strategies for overcoming them.