Recent advances in hydrogel-based anti-infective coatings

Bacterial infections associated with biomedical devices and implants have posed a great challenge to global healthcare systems. These infections are mainly caused by bacterial biofilm formed on the surface of biomaterials, protecting the encapsulated bacteria from conventional antibiotic treatment and attack of the immune system. As the bacterial biofilm is difficult to eradicate, bactericidal and antifouling coatings have emerged as promising strategies to prevent biofilm formation and subsequent infections. Hydrogels with three-dimensional crosslinked hydrophilic networks, tunable mechanical property and large drug-loading capacity are desirable coating materials, which can kill bacteria and/or prevent bacterial adhesion on the surface, inhibiting biofilm formation. Herein, we review recent developments of hydrogels as anti-infective coatings. Particularly, we highlight two chemical approaches (graft-from and graft-to), which have been used to immobilize hydrogels on surfaces, and present advances in the development of bactericidal (contact-killing and antimicrobial-releasing), antifouling (hydrophilic polymer network) and bifunctional hydrogel coatings with both bactericidal and antifouling activities. In addition, the challenges of hydrogel coatings for clinical applications are discussed, and future research directions of anti-infective hydrogel coatings are proposed.