Table 2.

Studies describing the efficacy of antimicrobial coatings based on chitosans associated with compounds displaying antimicrobial activity

CS-based coatings	Material	Medical application	Species	Major conclusions	Reference
Antimicrobial agents
Rifampicin	CS filmsb,c	Long-term medical devices	S. aureusf S. epidermidisf	Bacterial cells were not able to grow on CS-rifampicin surfaces after 72 h incubation.	(Cao and Sun, 2009) d
pH-responsive tobramycin-embedded micelles	Polydopamine-modified titanium surfacesb	Orthopedic implants	E. colig S. aureusf	Adhered bacteria were significantly lower (p< 0.05) on CS-tobramycin-coated surfaces than on the control group at 4 (1.18%), 12 (0.16%), 24 (0.25%), and 48 h (0.23%).	(Zhou et al., 2018) e
Amoxicillin/clavulanic acid (CoAM)	Siliconeb,c	Tympanostomy tubes	S. aureusf	CS-CoAM-coated silicone films exhibited a high efficacy (> 93%) in the prevention of biofilm formation on the tube surface.	(Ajdnik et al., 2019)
Disinfectant agents
Hyaloronic acid (HA)/triclosan	Modified titanium surfacesb,c	Medical implants	S. aureusf	Bacteria adhered to CS-HA surfaces lost their viability by 72%, while bacteria attached to the CS-HA/triclosan-coated surface showed a total loss in viability.	(Valverde et al., 2019) d
Enzymes
Lysozyme	Stainless steel surfacesb	Medical implants and devices	S. aureusf	S. aureus viability decreased by more than 70% after 2h incubation with CS-lysozyme coatings, and > 95% after 4 h.	(Yuan et al., 2013) d
Proteases	NDb	Indwelling medical devices	L. monocytogenesh P. aeruginosai S. aureusf	The antibiofilm activity of proteases was observed after 24 h of incubation; bead mobility was increased with Protease B (36%), Alcalase (57%), and Neutrase (84%).	(Elchinger et al., 2015) e
Cellobiose dehydrogenase (CDH) and deoxyribonuclease I (DNase)	Polystyrene microtiter platesb	Indwelling medical devices	C. albicansj S. aureusf	Biofilms of S. aureus, C.albicans, or mixed species were inhibited by CS nanoparticles-DNase-CDH by 99%, 89%, and 91%, respectively. In addition, these composites caused 80% biofilm disruption on mono- and polymicrobial biofilms.	(Tan et al., 2020)n.d.
Antimicrobial peptides (AMP)
Hyaluronic acid (HA)/β-peptide (coumarin-linker-(ACHC-B3hVal-B3hLys)3	Polyethylene cathetersa,b	Central venous catheters	C. albicansj	In vitrostudies: Biofilms formed on CS-HA-coated catheters reduced their metabolic activity by 80% compared to control. Catheter loading with β-peptide resulted in substantial reductions in biofilm growth (≈10%). In vivostudies: Biofilms formed on CS-HA-coated catheters were less robust than those observed on bare catheters. Tubes coated with β-peptide-loaded CS-HA films exhibited either no or very few yeast cells.	(Raman et al., 2016) e
	Titanium surfacesb	Orthopedic implants	S. aureusf	Results demonstrated that coatings loaded with β-peptide prevented the formation of S. aureus biofilms for up to 24 days. After 36 days, biofilm viability reduced 60% compared to bare titanium.	(López et al., 2019)
α-helical AMP MSI-78(4-20) (KFLKKAKKFGKAFVKIL)	Gold substratesb	Bone implants and other medical devices	S. epidermidisf	The AMP-chitosan coating did not significantly reduce bacterial adhesion but decreased the viability of adhered cells by 60%.	(Monteiro et al., 2020)

n.d., not described.

^ain vivo study.

^bin vitro study.

^cstudy performed under hydrodynamic conditions.

^ddip coating.

^elayer-by-layer assembly.

^fStaphylococcus sp.

^gEscherichia sp.

^hListeria sp.

ⁱPseudomonas sp.

^jCandida sp.