Antimicrobial hydrogels: promising materials for medical application

International Journal of Nanomedicine Dovepress open access to scientific and medical research Review International Journal of Nanomedicine downloaded from https://www.dovepress.com/ by 37.59.46.207 on 03-Dec-2018 For personal use only. Open Access Full Text Article Antimicrobial hydrogels: promising materials for medical application This article was published in the following Dove Press journal: International Journal of Nanomedicine Kerong Yang Qing Han Bingpeng Chen Yuhao Zheng Kesong Zhang Qiang Li Jincheng Wang Department of Orthopedics, The Second Hospital, Jilin University, Changchun, Jilin, People’s Republic of China Introduction Correspondence: Jincheng Wang Department of Orthopedics, The Second Hospital, Jilin University, No 218 of Ziqiang Street, Changchun, Jilin 130041 People’s Republic of China Tel +86 431 8879 6747 Fax +86 431 8879 6747 Email Qing Han; Bingpeng Chen Department of Orthopedics, The Second Hospital, Jilin University, No 218 of Ziqiang Street, Changchun, Jilin 130041, People’s Republic of China Email ; Nowadays, with the rapid development of biomaterials and medical devices, health care-associated infections (HAIs) have posed severe problems on clinicians. For example, in the US, the annual costs associated with HAIs are estimated to be up to $33 billion.1 The rapid emergence of antibiotic resistance in pathogenic microbes is becoming an imminent global public health problem.2 According to a report in Lancet, most acute sequelae and global mortality were caused predominantly by infectious diseases.3 Medical devices may bring HAIs to patients in hospital. These biomaterials and medical devices including joint implants, wound dressings, catheters, cardiac pacemakers and contact lenses bring implant-associated infection, calling for an urgent need of inherent antimicrobial biomaterials and medical devices. Among all antimicrobial materials, heavy metals and natural extracts have been used for a long time since first discovered. However, these materials still have inherent disadvantages that restrict their application and efficacy. They fight against microbes as well as normal cells which cause damage to normal organs and tissues of patients.4 Antibiotics emerged in antimicrobial history 80 years ago when penicillin was discovered by Sir Alexander Fleming.2 For all these decades, antibiotics have brought us consolation until the existence of drug-resistant bacterium was discovered. At the beginning of antibiotic resistance development, conventional antibiotics such as penicillin and methicillin were 2217 submit your manuscript | www.dovepress.com International Journal of Nanomedicine 2018:13 2217–2263 Dovepress © 2018 Yang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IJN.S154748 Powered by TCPDF (www.tcpdf.org) Abstract: The rapid emergence of antibiotic resistance in pathogenic microbes is becoming an imminent global public health problem. Local application of antibiotics might be a solution. In local application, materials need to act as the drug delivery system. The drug delivery system should be biodegradable and prolonged antibacterial effect should be provided to satisfy clinical demand. Hydrogel is a promising material for local antibacterial application. Hydrogel refers to a kind of biomaterial synthesized by a water-soluble natural polymer or a synthesized polymer, which turns into gel according to the change in different signals such as temperature, ionic strength, pH, ultraviolet exposure etc. Because of its high hydrophilicity, unique three-dimensional network, fine biocompatibility and cell adhesion, hydrogel is one of the suitable biomaterials for drug delivery in antimicrobial areas. In this review, studies from the past 5 years were reviewed, and several types of antimicrobial hydrogels according to different ingredients, different preparations, different antimicrobial mechanisms, different antimicrobial agents they contained and different applications, were summarized. The hydrogels loaded with metal nanoparticles as a potential method to solve antibiotic resistance were highlighted. Finally, future prospects of development and application of antimicrobial hydrogels are suggested. Keywords: nanomaterials, hydrogels, nanoparticles, antibiotics, drug delivery, infection Dovepress International Journal of Nanomedicine downloaded from https://www.dovepress.com/ by 37.59.46.207 on 03-Dec-2018 For personal use only. Yang et al noneffective to resistant strains. Now, vancomycin-resistant and linezolid-resistant strains have emerged. This has led to ceaseless demands for novel antibiotics, putting clinicians in a dilemma whether to test a novel multi-resistant strain with another antibiotic.5 Synthetic antimicrobial agents such as salicylate, chlorhexidine, isothiazolinones, thiosemicarbazones, octenidine and even quaternary ammonium compounds also faced progressive threats with the development of drug resistance.6 According to the Darwinian view of the role of antibiotics, it is widely accepted that antibiotics and antibiotic-resistant genes act as weapons and shields in shaping the structures of microbial communities.7 Nowadays, antibiotic resistance is considered as bacteria’s specific response to an injury caused by antibiotics, which means it cannot be totally avoided even if we create a new antibiotic agent.8 Increasing rates of antibiotic resistance, drug allergies and antibiotic shortages further complicate the choice of antibacterial agents.9 Problems that the traditional antimicrobial agents faced include drug resistance, overdose and cytotoxicity. These problems urgently call for an efficient and safe delivery system of drug release, which can delay the release of toxic antimicrobial agents and reduce the risk of bacterial drug resistance. Apart from antibiotics, other antimicrobial materials also have their own problems in clinical application. In recent years, antimicrobial peptides (AMPs) have been reported to have antimicrobial properties (especially short sequences) because of their ionic structure; so, it is difficult to induce resistance of bacterium or formation of biofilm.10–13 However, AMPs are also hemolytic, toxic and easy to lose efficacy and hence, AMPs need an effective drug delivery system to avoid these side effects.12,14 Besides, antimicrobial amylolytic polymers, antimicrobial polys (...truncated)