Gynecological infections and implant-related complications, such as bacterial vaginosis (BV), pelvic inflammatory disease (PID), and endometritis, are exacerbated by biofilm-forming pathogens such as G. vaginalis , E. coli , and S. aureus , posing significant clinical challenges worldwide. These biofilms, resistant to antibiotics, contribute to chronic infections and device failures in gynecological implants. Rising antibiotic resistance underscores the need for innovative biomaterials. Chitosan, hyaluronic acid (HA) and alginate are three representative natural polysaccharides, showing broad application potential in antibacterial materials and tissue engineering due to their excellent biocompatibility, biodegradability and modifiable structures. In their natural forms, they exhibit a certain degree of anti-biofilm activity by inhibiting bacterial adhesion and disrupting bacterial membranes. Functional modification significantly enhances their antibacterial performance such as AMPs grafting, cross-linking, quaternization, and nanocomposites. This review explores the antibacterial mechanisms of natural polysaccharides in the vaginal microbiome and endometrial tissue, highlighting advances in functionalization with antimicrobial peptides, nanoparticles, and chemical modifications to enhance antibacterial efficacy. The toxicological effects of natural polysaccharide materials on gynecological tissues generally show the characteristics of mainly protective and restorative effects, rather than causing damage. Natural polysaccharides and their applications offer promising potential for infection-resistant, regenerative therapies in gynecology, promising safer and more effective interventions. • Polysaccharides functionalized with AgNPs and quaternization achieve >90% bacterial reduction in preclinical models, synergizing antibiofilm and regenerative effects in gynecological implants. • 3D-bioprinted chitosan scaffolds and self-healing hyaluronic acid hydrogels inhibit 70–85% biofilm formation while promoting endometrial and vaginal tissue repair. • Photothermal-enhanced polysaccharide coatings and enzyme immobilization strategies overcome antibiotic resistance, enabling localized, cytotoxicity-controlled antimicrobial action. • Electrostatic disruption of bacterial membranes and quorum sensing inhibition by modified polysaccharides offer dual mechanisms to combat multidrug-resistant gynecological pathogens.
Hao et al. (Fri,) studied this question.