Emerging trends of multifunctional biomaterial scaffolds for targeted antibacterial therapy and enhanced bone regeneration in osteomyelitis.

A biocompatible scaffolds repairs bone defects with anti-infection properties in the treatment of osteomyelitis. Osteomyelitis is a severe infection of bone marrow, caused by Staphylococcus aureus, leading to inflammation and bone destruction. This condition manifests either acutely or chronically, influenced by factors such as diabetes-related vascular insufficiency, trauma, and surgical interventions. It involves bacterial colonisation of bone tissue, activation of the immune response, biofilm formation, and invasion of the osteocytes' lacuno-canalicular network, contributing to chronic infection. Current treatments face limitations due to systemic antibiotic inefficiency and the need for invasive procedures. Scaffolds have emerged as a promising solution for osteomyelitis management, offering structural support and localised delivery of antimicrobial agents. These biocompatible materials, ranging from natural polymers like collagen and chitosan to synthetic biodegradable materials such as Poly(lactic-co-glycolic acid), Polylactic acid, and Fibrin silk, address infection while promoting bone regeneration. The review highlights the potential of scaffolds-based strategies in treating osteomyelitis, focusing on their ability to overcome biofilm resistance and promote tissue repair. Novel antibiotic formulations for localised delivery, and combination therapies integrating osteogenic agents with antimicrobial drugs are helping in advanced therapeutic strategies. These address current challenges in clinical translation by optimising scaffold design and improving stability.