Antibacterial surface engineering: bioinspiration from leaves to medical devices

Healthcare-acquired infections (HAIs) and the rise of antimicrobial resistance (AMR) are critical global health challenges, necessitating innovative solutions to combat pathogenic bacteria. Traditional approaches, such as antibiotics and chemical disinfectants, are increasingly ineffective due to the rapid evolution of resistant strains and their associated side effects and environmental impacts. The development of antimicrobial physical surface design strategies presents a promising alternative for reducing microbial colonisation and transmission. This review provides a comprehensive examination of antimicrobial surface geometries and topographies, focusing on physical surface strategies that prevent bacterial adhesion and biofilm formation. Inspired by naturally occurring structures such as insect wings and lotus leaves, these engineered surfaces employ nano- and micro-scale patterning to exert mechanical forces that disrupt microbial cells through membrane rupture or inhibit their attachment by limiting surface area for successful adhesion. We discuss key fabrication methods, mechanisms of action, material considerations, and clinical relevance, while also addressing challenges such as scalability, durability, and regulatory issues. By highlighting both the potential and limitations of physical surface modifications in healthcare environments, this review aims to inform future research and promote the integration of surface-based strategies in the design of next-generation medical devices and high-touch clinical surfaces.