Advances in nanotechnology for addressing biofilm-related challenges in medical devices

Abstract Medical device-associated infections remain a major clinical challenge due to the rapid formation of microbial biofilms on device and implant surfaces. Biofilms are estimated to be involved in approximately 65% of microbial infections and up to 80% of chronic infections. Once established on device surfaces, these biofilms exhibit profound antibiotic tolerance, making infections difficult to eradicate, prone to relapse, and often necessitating invasive device removal, thereby imposing substantial clinical and economic burdens. These biofilms drive persistent infections that are highly tolerant to systemic antimicrobials because of restricted drug penetration, reduced metabolic activity, and adaptive resistance. Catheter-related bloodstream infections exemplify these impacts, contributing to elevated morbidity, prolonged hospitalization, and increased healthcare costs. When drug therapy fails, device removal is often required but may not be feasible for high-risk patients. Nanotechnology offers an emerging solution through interface-engineered surfaces and targeted antibiofilm strategies. Nanostructured coatings can inhibit initial microbial adhesion, while nanocarriers can penetrate established biofilms and deliver high local concentrations of antimicrobial agents with minimal systemic exposure. This review summarizes the mechanisms of biofilm formation, the limitations of current treatments, and recent advances in nanotechnology-based approaches for preventing and eradicating device-associated biofilms, and discusses the key challenges for clinical translation.