Antimicrobial coatings for bone regenerative scaffolds: Fabrication strategies and in vitro performance ─ A systematic review

Abstract

Polymeric scaffolds coated with antimicrobials are promising for the treatment and prevention of osteomyelitis. The literature gap regarding the in vitro viability and applicability of these biomaterials throughout their development pipeline (manufacturing technique and coating method), mechanical properties, antimicrobial capacity, and osteoblastic viability motivated this systematic review to answer the question, "What is the state of the art of antimicrobial-coated scaffolds for bone tissue engineering?". This review was structured according to the PRISMA guidelines, and the search strategy was applied to four databases and the grey literature, without time or language restrictions. The selection process occurred in two phases, blinded and performed independently by the reviewers. Eligibility criteria included in vitro experimental studies that evaluated antimicrobial-coated scaffolds for mechanical properties, antibacterial activity, and cytocompatibility. Of the 635 articles identified, 8 were included, and all had an overall low risk of bias. These were evaluated for fabrication technique, coating method, compression/tension behavior, osteoblastic viability, and antibacterial activity. The limited and heterogeneous literature available suggests that the addition of antimicrobial coating conferred potential antibacterial activity to scaffolds without negatively affecting mechanical performance. The class and concentration of the antibacterial agent appears to influence osteoblastic viability, with dose-dependent cytotoxicity. The available evidence does not allow the identification of which coating approaches, fabrication methods, or antimicrobial concentrations are most effective for specific clinical scenarios—such as acute versus chronic osteomyelitis or weight-bearing versus non-weight-bearing anatomical sites.