Medical titanium surface-modified coatings with antibacterial and anti-adhesive properties for the prevention of implant-associated infections

Implant-associated infections (IAIs) caused by drug-resistant bacteria remain a critical factor in the failure of implant procedures. Therefore, it is urgent to develop an effective anti-infection coating for implant surface modification to prevent IAIs. Herein, an antibacterial and anti-adhesive coating (CMP-Ti) constructed on the surface of titanium implants is reported, formed by the nanomaterial CeO2@Mn3O4 NRs (CM NRs) with antibacterial activity and the superhydrophilic polymer polyethylene glycol (PEG). The nanocatalyst CM NRs on the surface of CMP-Ti induce ferroptosis-like death of bacteria by catalyzing the production of hydroxyl radical (•OH) and singlet oxygen (1O2) and the consumption of glutathione (GSH). The superhydrophilic coating of CMP-Ti can effectively prevent adherence of drug-resistant bacteria and avoid biofilm formation. By combining the "active offense" antibacterial mechanism with the "passive defense" anti-adhesion mechanism, CMP-Ti can kill bacteria and inhibit biofilm formation. The results of in vivo studies showed that CMP-Ti effectively prevented implant-associated infections caused by Methicillin-resistant Staphylococcus aureus (MRSA), thus promoting tissue repair and osseointegration. Therefore, this multifunctional coating combining "active offense" and "passive defense" provides a promising way to prevent IAIs caused by drug-resistant bacteria and to promote tissue repair in the future.