Advances of chemistry for the design of antimicrobial biomaterials

Despite the substantial progress in the understanding of bactericidal mechanisms and the development of novel antimicrobial strategies, infections remain a major threat for the humankind. It is symptomatic that antibiotic-resistant bacterial infections are now the third most common cause of death, being inferior only to stroke and coronary heart disease. Another increasingly serious threat is posed by fungal infections, especially for hospitalized patients with immunodeficiency or those who recover from COVID-19. The main feature of this review is that it provides a unified systematic view on the control of pathogenic microorganisms. The review begins with a historical account and setting of relevant tasks for innovative medical materials and proceeds with a profound analysis of fundamental mechanisms and advanced solutions. The analysis focuses on the key strategies for controlling bacterial and fungal infections, which are considered in detail in relation to metallic and polymeric biomaterials, inorganic nanoparticles and heterogeneous platforms based on them for local therapy. Particular attention is paid to factors that regulate the release of ions and therapeutic agents, generation of reactive oxygen species, and synergistic effects involved in these processes. The review also addresses the antibacterial mechanisms of action of nanoparticles and metal-containing complexes, nanoparticle toxicity and ways to minimize it, and bacterial defence mechanisms against ions and nanoparticles. The achievements of modern chemistry related to surface functionalization and immobilization of therapeutic agents aimed at developing highly effective antimicrobial surfaces are demonstrated. Critical analysis of drawbacks of the existing models for in vitro and in vivo assays of the antibacterial activity of biomaterials is given. The bibliography includes 361 references.