Implantable biomedical materials for treatment of bone infection

Abstract

The treatment of bone infections has always been difficult. The emergence of drug-resistant bacteria has led to a steady decline in the effectiveness of antibiotics. It is also especially important to fight bacterial infections while repairing bone defects and cleaning up dead bacteria to prevent biofilm formation. The development of biomedical materials has provided us with a research direction to address this issue. We aimed to review the current literature, and have summarized multifunctional antimicrobial materials that have long-lasting antimicrobial capabilities that promote angiogenesis, bone production, or "killing and releasing." This review provides a comprehensive summary of the use of biomedical materials in the treatment of bone infections and a reference thereof, as well as encouragement to perform further research in this field.

Keywords: biological materials; bone infection; implantable material; multifunctional material; multifunctionalization of materials; progress of infection treatment; treatment of bone infection.

SCHEME 1

Antimicrobial treatment strategies for osteomyelitis.

FIGURE 1

(A) Schematic diagram of the antimicrobial mechanism of scaffolds of HACC. (B) Proportion of dead cells in various scaffolds after 24-h co-culture of hMSCs on the surface of HACC scaffolds. *p < 0.01 compared to P and P/H scaffolds. **p < 0.01 compared to other scaffolds. (C) Mean bacterial load curve measured by in vivo bioluminescence (p < 0.01). (D) Quantification of bacteria in cultures from rats (*p < 0.01 compared to P and P/HA scaffolds). Copyright 2016, Elsevier Ltd. Reproduced with permission (Yang et al., 2016).

FIGURE 2

(A) Schematic diagram of the antimicrobial effect of the magnesium/zinc metal coating. (B) Quantitative statistics of implant surface bacterial inhibition on coated plate images, n = 8, **p < 0.01. (C) Antibacterial effect of S. aureus under different substrates, n = 6, *p < 0.05 and **p < 0.01. (D) Antibacterial effect of E. coli under different substrates, n = 6, *p < 0.05 and **p < 0.01. Copyright 2019, Elsevier Ltd. Reproduced with permission (Shen et al., 2019).

FIGURE 3

(A) Conceptual diagram of the organic-inorganic hybrid antimicrobial coating. (B) Analysis of the adhesion of E. coln different coatings. **p < 0.01, ***p < 0.001. (C) Analysis of the adhesion of S. mutans to different coatings. **p < 0.01, ***p < 0.001. (D) OD test to detect E. coil growth inhibition. (E) OD test to detect S. mutans growth inhibition. Copyright 2019, American Chemical Society with permission (Cheng et al., 2019).

FIGURE 4

(A) Schematic representation of the function of TiO₂/GDY and its application in orthopedic implant infections. (B) Bacterial colony plate counts in implant femoral grinds of the infection model. (C) Quantitative analysis of bacterial colonies in the infection model. *p < 0.0002; **p < 0.0001; ***p < 0.0001). Copyright © 2020, The Author(s). Reproduced with permission (Wang et al., 2020b).

FIGURE 5

(A) Schematic diagram of the smart antimicrobial surface, which can function according to pH change. (B) Reversible binding of lysozyme by pH switching of the SiN-PMAA surface. (C) Reversible attachment of E. coli by pH switching on the SiN-PMAA surface. (D) Release of lysozyme in solution when the pH changes from 4 to 7. The inset shows the Si and Si-PMAA surfaces. (E) Comparison of lysozyme release ratios from pH 4 to 7 on antimicrobial surfaces. (F) Comparison of the relative enzymatic activity of free lysozyme at pH 4 and 7. Error bars represent the standard deviation of the mean (n = 3). Copyright © 2016, The Author(s). Reproduced with permission (Wei et al., 2016).