Addressing bacterial threats in a post-antibiotic era: Bioinspired strategies for antibacterial surface design

The advent of antibiotics revolutionized the management of bacterial infections, yet their clinical efficacy is catastrophically undermined by the global emergence of antimicrobial resistance (AMR). Furthermore, the situation is aggravated by the fact that the formation of bacterial biofilm on material surfaces significantly enhances their tolerance to antibiotics. Therefore, there is an urgent need for new approaches that employ antibacterial mechanisms distinct from those of conventional antibiotics to mitigate the risk of AMR. Recently, naturally occurring surfaces found on typical plants and insects that take advantage of physical topography can either inhibit bacterial adhesion or directly inactivate bacterial cells, showing innovative “outside-the-box” prospects for antibacterial applications and garnering considerable interest due to their drug-free nature. Bioinspired micro-/nanostructures that mimic natural surface patterns have been replicated on various biomaterials to enhance their antibacterial properties. This review summarizes and explains the current advances in bioinspired antibacterial surfaces, as well as the underlying mechanisms of various strategies. Subsequently, synergistic antimicrobial surfaces, comprising a combination of various physical antibacterial strategies, are reviewed to highlight their potential for highly efficient disinfection and long-lasting antibacterial performance. Finally, the biomedical applications, coupled with the future challenges of bio-inspired antibacterial strategies, were further discussed. We hope this review could provide valuable insights for developing innovative, antibiotic-free antibacterial strategies that deliver powerful performance in combating AMR.