Designing Intelligent Antibacterial Systems via Piezoelectric Catalysis: Mechanisms and Pharmaceutical Perspectives

Antimicrobial resistance (AMR) is a critical global health challenge driven primarily by the inappropriate and excessive use of antibiotics in veterinary and human medicine. The misuse of antibiotics has contributed to the emergence of resistant bacteria, a situation increasingly described as a "silent pandemic" and projected to cause a substantial global mortality burden by 2050. AMR threatens both human and animal health by diminishing the effectiveness of antimicrobial therapy and making infections increasingly difficult to treat. Bacteria can evade conventional antibiotics through several mechanisms, including enzymatic degradation, active efflux, target-site mutations, reduced membrane permeability, and biofilm formation. Recently, piezoelectric catalysis has gained attention as an alternative antibacterial strategy based on the generation of Reactive Oxygen Species (ROS) under localized electric fields induced by mechanical stimulation, resulting in bacterial cell damage regardless of the resistance phenotype. This review outlines the mechanisms and evolution of AMR and highlights the antibacterial potential of piezoelectric materials grouped by family, including metal oxides such as ZnO and BaTiO3, transition metal sulfides such as MoS2, heterojunctions such as KNbO3/MoS2, and organic polymers such as PVDF. Current evidence indicates that ultrasonic activation of BaTiO3- and ZnO-containing materials can eliminate more than 97% of multidrug-resistant microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli, through ROS-mediated oxidative stress and electroporation. Despite promising findings from in vitro and preclinical studies, several translational barriers remain, including potential cytotoxicity associated with excessive ROS generation, challenges in scalable nanomaterial fabrication, and regulatory approval requirements. Future applications may include implant coatings, self-sterilizing wound dressings, and other infection-control technologies. Overall, this review provides a framework for future research by discussing the molecular basis, material-design strategies, and clinical translation challenges of piezocatalytic antibacterial systems in the fight against AMR.