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International Journal of Bioprinting 3D printing innovations against infection

1. Introduction precisely influences cell attachment and biofilm generation
by adjusting the physical and chemical properties of the
Currently, three-dimensional (3D) printing technology implant surface. 19
finds extensive applications in the field of healthcare, which
extend beyond the manufacturing of precision medical Over the past decade, 3D printing technology has
instruments and surgical models. It provides innovative been profoundly impacting the development of anti-
customized solutions in diversifying medical implants infection materials and tissue engineering. In comparison
for different purposes such as artificial joint prosthetics, to traditional manufacturing methods, 3D printing
scaffolds, and dental implants. This personalized boasts numerous significant advantages. Primarily, it
manufacturing process significantly enhances the success reduces equipment costs, expedites the processes of
rate of surgeries, reduces procedural risks, and alleviates prototyping and product development, and offers an
patient discomforts. However, despite the benefits afforded expansive realm for innovation. 20-22 Moreover, the unique
1
by this technology, issues related to bacterial infections and attribute of 3D printing lies in its capacity to deliver
immune reactions triggered by foreign structures implanted highly customized antimicrobial products tailored to
2
in the body remain worthy of attention. The implant the specific requirements of distinct applications. This
infections account for approximately 26% of all healthcare- customization enhances adaptability to patient needs or
related infections in the United States, including catheter- specific environmental conditions, thereby augmenting
3
23
associated urinary tract infections (CAUTI), central line- therapeutic outcomes. Furthermore, 3D printing enables
associated bloodstream infections, ventilator-associated the fabrication of items with intricate internal structures,
pneumonia, as well as infections related to artificial joints effectively increasing the antimicrobial surface area.
and implanted prosthetics. Bacteria in nature exist in This structural complexity contributes to more efficient
4
two forms: planktonic (free-floating) and sessile bacteria inhibition of bacterial growth and bactericidal efficacy. 24,25
(attached to surfaces). These two phases can alternate Advancements in this technology are poised to enhance
between each other. Upon settling on biological or non- the functionality of medical devices and implants, and to
5
biological surfaces, bacteria secrete extracellular polymeric catalyze innovations in the realm of antimicrobial materials
substances (EPS) that adhere to the material surface forming and tissue engineering.
biofilm. Both Gram-positive and Gram-negative bacteria The role of 3D-printed materials is not limited to fighting
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can form biofilms on medical materials, but approximately bacterial infections in implants, but also shows significant
two-thirds of implant material infections are attributed to potential in the antiviral field, playing a key role during the
Staphylococcus species. Notably, Staphylococcus aureus coronavirus disease 2019 (COVID-19) outbreak. First, by
7,8
(S. aureus) and Staphylococcus epidermidis (S. epidermidis) creating personal protective equipment (PPE) with antiviral
can result in infection rates of 40%–50% for artificial heart properties, these medical devices can effectively block the
valve prosthetics and 50%–70% for catheter-associated transmission and deposition of viruses, thereby protecting
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biofilm infections. The presence of such biofilms serves as healthcare workers and communities from viruses such as
10
the fundamental cause of biomaterial-associated infections. severe acute respiratory syndrome coronavirus 2 (SARS-
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The principal causes of implant infections include CoV-2). Second, the flexibility of 3D printing technology
bacterial attachment and compromised host immunity, allows the antiviral properties of materials to be adjusted
primarily through biofilm formation on the implant as needed, improving their adaptability, and making them
surface. Biofilms create an optimal environment for more efficient against pathogens. The rapid response aided
bacterial attachment, enabling them to evade the immune by the efficiency in producing 3D-printed materials was
system, resist antibiotic effects, and eventually lead to critical for orchestrating the response to the COVID-19
implant failure. 11-13 Current treatments, predominantly pandemic. By rapidly producing innovative PPE to counter
implant removal or surgical excision of infected tissue, COVID-19 infection, this technology greatly alleviated
harbor high infection risks and necessitate repeated the shortage of medical supplies and provided urgent and
surgeries for patients. Therefore, aggressive prophylaxis critical support in preventing the spread of the virus.
14
is urgently needed to prevent biofilm infections. Among In order to better understand the potential and
which, antimicrobial coatings are highly regarded as limitations of this technology, this paper meticulously
advanced tools. The prophylactic process involves delves into the progress of the 3D printing technology,
15
not only covalent immobilization of anti-microbial elucidating the associated mechanisms and preventive
substances onto the material surface but also the creation strategies against microbial and COVID-19 infection. This
of an internal drug delivery system. This system ensures comprehensive review expounds the profound clinical
sustained drug release, effectively inhibiting biofilm and implications of 3D-printed anti-infection materials,
bacterial growth. 16-18 Simultaneously, surface modification highlighting the optimism in the continuous developments

Volume 10 Issue 4 (2024) 124 doi: 10.36922/ijb.2338