Microbial resistance to nanotechnologies: An important but understudied consideration using antimicrobial nanotechnologies in orthopaedic implants

Abstract

Microbial resistance to current antibiotics therapies is a major cause of implant failure and adverse clinical outcomes in orthopaedic surgery. Recent developments in advanced antimicrobial nanotechnologies provide numerous opportunities to effective remove resistant bacteria and prevent resistance from occurring through unique mechanisms. With tunable physicochemical properties, nanomaterials can be designed to be bactericidal, antifouling, immunomodulating, and capable of delivering antibacterial compounds to the infection region with spatiotemporal accuracy. Despite its substantial advancement, an important, but under-explored area, is potential microbial resistance to nanomaterials and how this can impact the clinical use of antimicrobial nanotechnologies. This review aims to provide a better understanding of nanomaterial-associated microbial resistance to accelerate bench-to-bedside translations of emerging nanotechnologies for effective control of implant associated infections.

Graphical abstract

Highlights

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  Current understanding of mechanisms of microbial resistance were overviewed.

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  Potential risks of microbial resistance by using different antibacterial nanotechnologies were evaluated.

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  Correlation of design principle, composition, surface functionalization, structural modifications of different antibacterial nanomaterials to microbial resistance was discussed.

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  Challenges and future opportunities of antibacterial nanotechnologies for implant associated infection were discussed, targetting clinical development and industrial scalability.