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The state-of-the-art in AMC

Bacteria growing in a petri dishes
Bacteria growing in a petri dishes

Novel antibiotic drugs are scarce and increasing resistance against antimicrobial drugs is established. Innovations that tackle rising and prominent threats in healthcare are demanded. Preventive innovations are needed to minimize microbial pressure in bacterial “hotspots”, like hospitals, nursing homes or day-care centres. For example, bacteria can persist for many months on inanimate surfaces, forming an ongoing source of transmission. Healthcare workers can transfer these microbes to the patient after touching contaminated surfaces. Also, biofilms harbouring pathogenic bacteria can form on the surface of medical implants after surgery and are a source of poorly treatable recurrent infections. A state-of-the-art innovation to combat pathogenic bacteria is the creation of self-disinfecting surfaces through the application of coatings with antibiofouling and/or bactericidal properties. Particularly bactericidal coatings are interesting in healthcare because of the capability of these coatings to kill pathogens on contact. Many different chemical strategies and technologies for antibacterial coatings have been described. Antibacterial coatings may contain active eluting agents (e.g. ions or nanoparticles of silver, copper, zinc, or antibiotics, chloride, iodine, etc.), immobilized molecules that become active upon contact (e.g. quaternary ammonium polymers or peptides), or light-activated molecules (e.g. TiO2 or photosensitizers). As depicted in a recent market analysis (source: marketsandmarkets.com), the global market for these coatings is growing.

With an estimated market worth of $1.5 billion, the global AMC demand is expected to reach $2.9 billion in 2018. Only few studies are available on introduction of these AMC in healthcare, nevertheless results are promising indicating long-term efficacy of self-disinfecting coatings on surfaces. Clinical trials show that copper as an antimicrobial agent continuously reduces the bacterial burden by 83% and reduces the risk of infection by 58%. The evaluation of functional efficacy relies on conventional microbiological tests which are time consuming, highly labour intensive, difficult to standardize and field tests are lacking.

Progress beyond the state-of-the-art
So far, only little information has been published on the results of introduction of AMC in healthcare. In an intensive care unit in Los Angeles County, the application of AMC on various fomites such as bed rails, tray tables and walls was studied. The AMC assessed in the study was found to have persisted over 15 weeks in reducing the total amount of bacteria and antibiotic resistant bacteria on surfaces. The CuViTo FP7 program that ended in 2013 was working on manufacturing a copperbased AMC, but results on validation of the AMC in hospitals are not available (yet). Also, the SelfClean project mentions progress in the development of self-cleaning, antibacterial coatings based on the incorporation of doped TiO2 nanoparticles in Sn-Ni matrix, but validation studies of these coatings are not yet available.

Innovation in tackling the challenge
Starting from AMCs that are currently being developed or that are ready for validation the network will combine all available results on AMC innovations to further develop AMC ready to use in healthcare. Innovative research on AMC and possible adverse effects, such as toxic emissions and development of AMR will be undertaken. Development of field tests and benchmarking of AMC will take place. Validation studies of AMC in healthcare, including new cleaning concepts will be performed.

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