Organic Polyurethane Surface Structures to Manufacture Noneluting Antimicrobial Polyurethanes: A Systematic Review of Literature

The dramatic increase in hospital-acquired infections and healthcare costs associated with infection treatment and antimicrobial resistance in implant infections necessitates further research and development of antimicrobial implant material properties. Polyurethanes are key biomaterials used in medical implants and devices. A variety of compounds, both synthetic and natural, can be incorporated into polyurethanes to provide them with contact-killing and/or bacteria-repelling properties. This systematic literature review presents an up-to-date, comprehensive overview of organic, antimicrobial surface-active polyurethanes, the compounds used to impart them with antimicrobial properties, their effectiveness, and mode of action. Technologies preventing bacterial adherence, contact-killing technologies, and environmental leaching are all analyzed. Highly effective compounds are reported but also compounds with low effectiveness. Overall, a genuine lack of standardization in methodological setup, outcomes, analysis, and reporting was discerned. Combined with ineffective technology, this hampers timely clinical implementation. Future research should focus on advancing the clinical efficacy while testing relevant models with high methodological quality, both in vitro and in vivo-bringing us one step closer to halting the rise of infection and antimicrobial resistance incidence by providing effective treatment technologies.