Biomaterial-associated infection (BAI) is considered a unique infection due to the presence of a biomaterial yielding frustrated immune-cells, ineffective in clearing local micro-organisms. The involvement of surface-adherent/surface-adapted micro-organisms in BAI, logically points to biomaterial surface-modifications for BAI-control. Biomaterial surface-modification is most suitable for prevention before adhering bacteria have grown into a mature biofilm, while BAI-treatment is virtually impossible through surface-modification. Hundreds of different surface-modifications have been proposed for BAI-control but few have passed clinical trials due to the statistical near-impossibility of benefit-demonstration. Yet, no biomaterial surface-modification forwarded, is clinically embraced. Collectively, this leads us to conclude that surface-modification is a dead-end road. Accepting that BAI is, like most human infections, due to surface-adherent biofilms (though not always to a foreign material), and regarding BAI as a common infection, opens a more-generally-applicable and therewith easier-to-validate road. Pre-clinical models have shown that stimuli-responsive nano-antimicrobials and antibiotic-loaded nanocarriers exhibit prolonged blood-circulation times and can respond to a biofilm's micro-environment to penetrate and accumulate within biofilms, prompt ROS-generation and synergistic killing with antibiotics of antibiotic-resistant pathogens without inducing further antimicrobial-resistance. Moreover, they can boost frustrated immune-cells around a biomaterial reducing the importance of this unique BAI-feature. Time to start exploring the nano-road for BAI-control.

中文翻译：

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超越表面改性策略来控制与植入生物材料和设备相关的感染 - 抓住纳米技术提供的机会

生物材料相关感染（BAI）被认为是一种独特的感染，因为生物材料的存在会产生受挫的免疫细胞，无法有效清除局部微生物。 BAI 中表面粘附/表面适应微生物的参与，逻辑上表明生物材料表面修饰可用于 BAI 控制。生物材料表面改性最适合在附着细菌生长成成熟生物膜之前进行预防，而通过表面改性进行 BAI 处理几乎是不可能的。数百种不同的表面修饰已被提出用于 BAI 控制，但由于统计上几乎不可能证明效益，因此很少通过临床试验。然而，临床上还没有提出任何生物材料表面改性方法。总的来说，这使我们得出结论：表面改性是一条死胡同。与大多数人类感染一样，承认 BAI 是由表面粘附的生物膜（尽管并不总是异物）引起的，并将 BAI 视为一种常见感染，这就开辟了一条更普遍适用且更容易验证的道路。临床前模型表明，刺激响应型纳米抗菌剂和负载抗生素的纳米载体表现出延长的血液循环时间，并且可以响应生物膜的微环境渗透并在生物膜内积聚，促进ROS的产生并与抗生素协同杀伤抗生素耐药性病原体，而不引起进一步的抗生素耐药性。此外，它们可以增强生物材料周围受挫的免疫细胞，从而降低这种独特的 BAI 功能的重要性。是时候开始探索 BAI 控制的纳米道路了。