The threats posed by the impending "postantibiotic era" have put forward urgent challenges to be overcome by providing new diagnostic and therapeutic regimes for improved diagnosis and treatment of bacterial infections. Antibiotic resistance and incurable bacterial infections are especially important in a society faced with rapid demographic changes. With very few new antibiotics in the drug development pipeline, not being able to match the pace of antimicrobial resistance evolution, developments within other fields such as materials sciences and medical technologies are required to realize innovative antibacterial approaches. This progress report presents recent advances in especially nanotechnology-based approaches and their concomitant use with complementary antibacterial treatments. Synergistically improved antibacterial activity can be reached by considering novel, promising approaches such as photodynamic and photothermal therapy as well as cold atmospheric pressure treatments as complementary strategies to fight against antibacterial resistance. Moreover, this report describes how these novel technologies can be further improved especially by integration of nanomaterials into the currently applied single modal strategies against bacterial infections.

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Aim: The random use of antimicrobials for years has led to bacterial DNA mutation and a result of that, bacteria have become resistant to antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA) is among these types of resistant bacteria that can easily infect when the immune system of the host is suppressed, and it significantly delays the wound healing. Different treatment methods are being investigated to overcome this problem. Antimicrobial photodynamic therapy is a candidate to become an alternative treatment for the destruction of MRSA. The aim of this study was to investigate the effect of chlorin e6 for the photoinactivation of MRSA and the synergetic role of ethanol in this mechanism. Methods: 655 nm laser light and Chlorin e6 as photosensitizer were examined for the photoinactivation of MRSA. Besides, 20% ethanol was used to increase the total antimicrobial efficacy with lower light energy densities and photosensitizer concentrations. The colony counting method was used to determine viable bacterial cells after each application. Results: 25 J/cm2 energy density with 20 μM Chlorin e6 and 50 J/cm2 energy density with 10 μM Chlorin e6 showed the highest bactericidal activity. When 20% ethanol was used as an adjuvant, 25 J/cm2 energy dose with 2 μM Chlorin e6 resulted in a better killing effect. Conclusion: Chlorin e6-mediated photodynamic therapy was successful to destroy MRSA and the addition of ethanol provided the opportunity to obtain higher antibacterial activity with lower light intensities and photosensitizer concentrations.

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