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 fail-ure of implant procedures.Therefore,it is urgent to develop an effective anti-infection coating for im-plant 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 CeO_(2)@Mn_(3)O_(4) 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(^(1)O_(2))and the consumption of glutathione(GSH).The superhydrophilic coating of CMP-Ti can effectively prevent adherence of drug-resistant bac-teria 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 osseointegra-tion.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.