Comprehensive Summary Implantable medical device‐associated infections (DAIs) originating from bacterial adhesion and biofilm formation have threatened to the health and life of patients. Antibacterial polymer coatings with antifouling and/or bactericidal properties have showed great potentials to combat DAI issues. In this review, we report recent advances in antibacterial polymer coatings fighting bacterial adhesion and biofilm formation on implantable biomaterial surfaces. We summarize the mechanisms of bacterial adhesion and biofilm formation, which provides guidance for the design of antibacterial coatings. We describe the polymer and coating preparation methods and discuss the structure‐property relationships of antibacterial polymer coatings. Applications of these polymer coatings in medical catheters, orthopaedic implants, and other applications are elaborated. Future challenges and prospects associated with antibacterial polymer coatings for implantable medical devices are discussed.

Inspired by the charge composition and distribution of proteins and peptides, we designed and prepared a series of brush polypeptides with positive and negative charges separately distributed in the side chains and the backbones. The brush polypeptides can self-or co-deposit on various substrates forming ultrathin and stable coatings. They showed potent bactericidal activity and antibiofilm property, outperforming conventional linear polypeptide coatings with randomly distributed positive and negative charges. Keeping the balance of positive/negative charges and increasing the numbers of positive/negative charges can further improve the antibacterial property of brush polypeptide coatings without sacrificing their biocompatibility.

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Surface modification with cationic polymer coatings represented an important strategy to address the medical devicerelated infection issues. However, limited antibacterial activities and high cytotoxicity have hampered their development. Herein, we report a facile method to enhance the surface antibacterial activity by construction of an imidazolium-based polypeptide with fosfomycin counteranions (i.e., S 4 -PIL-FS). The polypeptide coating displayed a synergistic antibacterial effect from the combination of membrane disruption and inhibition of initial cell wall synthesis, leading to higher in vitro and in vivo surface antibacterial activities than cationic polypeptide or fosfomycin sodium alone. S 4 -PIL-FS also showed a decrease in the hemolytic ratio and cytotoxicity toward different mammalian cells. Moreover, we observed an interesting biofilmresponsive property of S 4 -PIL-FS originating from the esteraseinduced cleavages of side-chain ester bonds that enabled an antibiofilm property of the cationic polypeptide coating.

Polymer coatings with improved surface antibacterial properties are of great importance for the application and development of implantable medical devices. Herein, we report the design, preparation, and antibacterial properties of a series of brush polymers (Dex-KEs) with hydrophilic dextran main-chains and mixed-charge polypeptide (KE) side-chains. Dex-KEs showed higher bactericidal activity and antifouling and antibiofilm properties than maleic acid modified dextran (Dex-Ma), KE, Dex-Ma/KE blend coatings, and brush polymer coatings with hydrophobic main-chains (AcDex-KEs). They also showed negligible in vitro cytotoxicity toward different mammalian cells and good in vivo biocompatibility. Dex-KE-coated implants exhibited potent in vivo resistance to bacterial infection before or after implantation.