Although high-performance carbon materials are widely used in surface engineering, with emphasis on carbon nanotubes (CNTs), the application of CNT nanocomposites on medical surfaces is poorly documented. In this study, we aimed to evaluate the antimicrobial and anti-adhesive properties of CNT-based surfaces. For this purpose, a PRISMA-oriented systematic review was conducted based on predefined criteria and 59 studies were selected for the qualitative analysis. Results from the analyzed studies suggest that surfaces containing modified CNTs, and specially CNTs conjugated with different polymers, exhibited strong antimicrobial and anti-adhesive activities. These composites seem to preserve the CNT toxicity to microorganisms and promote CNT-cell interactions, as well as to protect them from nonspecific protein adsorption. However, CNTs cannot yet compete with the conventional strategies to fight biofilms as their toxicity profile on the human body has not been thoroughly addressed. This review can be helpful for the development of new engineered medical surfaces.

Different studies have shown that the incorporation of carbon nanotubes (CNTs) into poly(dimethylsiloxane) (PDMS) enables the production of composite materials with enhanced properties, which can find important applications in the biomedical field. In the present work, CNT/PDMS composite materials have been prepared to evaluate the effects of pristine and chemically functionalized CNT incorporation into PDMS on the composite’s thermal, electrical, and surface properties on bacterial adhesion in dynamic conditions. Initial bacterial adhesion was studied using a parallel-plate flow chamber assay performed in conditions prevailing in urinary tract devices (catheters and stents) using Escherichia coli as a model organism and PDMS as a control due to its relevance in these applications. The results indicated that the introduction of the CNTs in the PDMS matrix yielded, in general, less bacterial adhesion than the PDMS alone and that the reduction could be dependent on the surface chemistry of CNTs, with less adhesion obtained on the composites with pristine rather than functionalized CNTs. It was also shown CNT pre-treatment and incorporation by different methods affected the electrical properties of the composites when compared to PDMS. Composites enabling a 60% reduction in cell adhesion were obtained by CNT treatment by ball-milling, whereas an increase in electrical conductivity of seven orders of magnitude was obtained after solvent-mediated incorporation. The results suggest even at low CNT loading values (1%), these treatments may be beneficial for the production of CNT composites with application in biomedical devices for the urinary tract and for other applications where electrical conductance is required.

Several methodologies have been implemented with the intent of preventing or reducing the formation of biofilms on indwelling urinary devices. The use of carbon nanotubes (CNTs) in the biomedical field has been increasing, particularly in the production of antimicrobial and antifouling coatings. Despite their proven antimicrobial properties, their use as coating materials for urinary tract devices (UTDs) is still poorly documented. In the present work, CNT/poly(dimethylsiloxane) (PDMS) composite materials containing different CNT loadings were prepared and further tested against Escherichia coli under conditions prevailing in UTDs. Besides CNT loading optimization, textural modifications were also introduced on the surface of CNTs to improve the antibiofilm properties of the final composites. Material characterization included the textural evaluation of CNTs and the assessment of surface morphology by scanning electron microscopy, while the surface hydrophobicity was determined by contact angle measurements. Biofilm analysis was performed by determining the number of culturable and total cells and by confocal laser scanning microscopy. Results revealed that, by filling the PDMS matrix with 3 wt% CNT loading, a significant reduction in cell culturability (39%) can be achieved compared to PDMS. Additionally, the textural modifications induced by ball-milling treatment proved to be effective on the inhibition of biofilm formation, reducing the amount of biofilm per surface area, biofilm thickness and surface coverage in 31, 47 and 27%, respectively (compared to surfaces where CNTs were not ball-milled).

Bio-contamination of water through biofouling, which involves the natural colonization of submerged surfaces by waterborne organisms, is a global socio-economic concern, allied to premature materials bio-corrosion and high human health risks. Most effective strategies release toxic and persistent disinfectant compounds into the aquatic medium, causing environmental problems and leading to more stringent legislation regarding their use. To minimize these side effects, a newly non-biocide-release coating strategy suitable for several polymeric matrices, namely polydimethylsiloxane and polyurethane (PU)-based coatings, was used to generate antimicrobial ceramic filters for water bio-decontamination. The best results, in terms of antimicrobial activity and biocide release, showed an expressed delay and a decrease of up to 66% in the population of methicillin-resistant Staphylococcus aureus bacteria on ceramic filters coated with polyurethane (PU)-based coatings containing grafted Econea biocide, and no evidence of biocide release after being submerged for 45 days in water. Biocidal PU-based surfaces were also less prone to Enterococcus faecalis biofilm formation under flow conditions with an average reduction of 60% after 48 h compared to a pristine PU-based surface. Biocidal coated filters show to be a potential eco-friendly alternative for minimizing the environmental risks associated with biofouling formation in water-based industrial systems.

The increasing incidence of implant-associated infections has prompted the development of effective strategies to prevent biofilm formation on these devices. In this work, pristine graphene nanoplatelet/polydimethylsiloxane (GNP/PDMS) surfaces containing different GNP loadings (1, 2, 3, 4, and 5 wt%) were produced and evaluated on their ability to mitigate biofilm development. After GNP loading optimization, the most promising surface was tested against single- and dual-species biofilms of Staphylococcus aureus and Pseudomonas aeruginosa. The antibiofilm activity of GNP/PDMS surfaces was determined by the quantification of total, viable, culturable, and viable but nonculturable (VBNC) cells, as well as by confocal laser scanning microscopy (CLSM). Results showed that 5 wt% GNP loading reduced the number of total (57%), viable (69%), culturable (55%), and VBNC cells (85%) of S. aureus biofilms compared to PDMS. A decrease of 25% in total cells and about 52% in viable, culturable, and VBNC cells was observed for P. aeruginosa biofilms. Dual-species biofilms demonstrated higher resistance to the antimicrobial activity of GNP surfaces, with lower biofilm cell reductions (of up to 29% when compared to single-species biofilms). Still, the effectiveness of these surfaces in suppressing single- and dual-species biofilm formation was confirmed by CLSM analysis, where a decrease in biofilm biovolume (83% for S. aureus biofilms and 42% for P. aeruginosa and dual-species biofilms) and thickness (on average 72%) was obtained. Overall, these results showed that pristine GNPs dispersed into the PDMS matrix were able to inhibit biofilm growth, being a starting point for the fabrication of novel surface coatings based on functionalized GNP/PDMS composites.

Hospital-acquired infections are still a major concern worldwide, being frequently related to bacterial biofilm formation on medical devices, and thus difficult to eradicate with conventional antimicrobial treatments. Therefore, infection-preventive solutions based on natural polymers are being investigated. Recently, a marine cyanobacterium-derived polymeric coating (CyanoCoating) has demonstrated great anti-adhesive potential when immobilized onto gold model substrates. In this work, we took this technology a step closer to an industrial application by covalently immobilizing CyanoCoating onto medical grade polyurethane (PU). This immobilization was developed through the introduction of linkable moieties onto a PU inert surface using different pre-treatments. Besides the application of the polydopamine (pDA) linker layer, other processes frequently found in industrial settings, such as atmospheric plasma (using O₂ or N₂ as reactive gases) and ozone surface activations, were evaluated. From all the pre-treatments tested, the ozone activation was the most promising since the obtained coating not only revealed a homogeneous distribution, but also significantly reduced the adhesion of two relevant etiological bacteria in static conditions (the Gram-positive Staphylococcus aureus and the Gram-negative Escherichia coli). Moreover, it also impaired E. coli biofilm formation under simulated urinary tract dynamic conditions, reinforcing the potential of CyanoCoating as an antibiotic-free alternative to mitigate medical device-associated infections, particularly in the urinary tract.