Strategic defenses: A review of novel approaches to combat nosocomial infections on medical implants.

Implant associated infections (IAIs), have remain a significant challenge due to persistent microbial colonization on the surfaces of medical implants often resulting in implant failure and increased post-operative complications. Various surface modification strategies have developed to mitigate the resistive biofilm formation on the surface of medical implants. With advancements in technology, many different strategies have emerged to prevent and eradicate the microbial colonization. There are various surface modification strategies and techniques applied on polymer-based and metallic medical implants to address the challenges of minimizing, inhibiting, and eradicating microbial colonization. These strategies include coating implant surfaces with layer-by-layer techniques of polymer encapsulating metal nanoparticles or antibacterial agents to enhance antibacterial properties, grafting techniques like plasma spray and plasma enhanced chemical vapor deposition coating the metal implant disc enhancing the antibacterial activity. Grafting of QAS and crosslinked polymers enables the trapping of bacterial moieties and disruption of their membranes due to difference in charge, thereby exhibiting strong biofilm inhibition. Multilayer coating of implants for active and localized released of therapeutic agents and surface activation via UV or plasma treatments to increase surface wettability. Emerging fabrication techniques on implant surfaces provides lithographic patterning, 3D printing, and electron deposition that changes topological cues of implant surface leading to change adhesion phenomenon of microbial moieties thereby efficiently inhibiting the colonization of microbes. Hence, this review provides an in-depth overview of innovative surface engineering approaches for polymer-based medical implants, focusing on strategies to prevent microbial colonization, boost antibacterial activity, and enhance sterility, durability, and therapeutic outcomes.