# Infection Control with Antimicrobial Solid-State ZnO Nanoparticles on Silk Fiborin Gauze
## 1 Introduction  
After the discovery of penicillin in 1928, which provided an effective treatment for bacterial infections, medicine moved towards an era of antibiotics, often referred to as the \"golden age\" [1]. However, overuse and misuse of antibiotics progressively led to the emergence of antibiotic-resistant bacteria, posing a serious global threat to public health. Bacterial resistance to antibiotics results primarily from genetic mutations altering the target of the drugs or through horizontal gene transfer, enabling the spread of resistance genes. Additionally, bacteria may employ mechanisms by export antibiotics outside the bacteria to reduce their action and by producing biofilm to evade antibiotic effects. The misuse of antibiotics accelerates this process, emphasizing the importance of responsible use and ongoing research for combating antibiotic resistance. Alternative strategies include using calcium-dependent antimicrobials [2], chemodynamic therapy [3], and combining several medications [4], leading to increased side effects and greater resistance from bacterial strainsto combinations of antibiotics. The emergence of toxicogenomic tools provides a great asset in understanding and addressing bacterial infections [5]. Through toxicogenomic approaches, the genomic responses of bacteria to antibiotics can be analyzed, gaining insights into resistance mechanisms and potential vulnerabilities. This genomic approach could guide the development of targeted therapies to overcome resistance and enhance the effectiveness of antibacterial treatments. But to pick out the most effective solution to these predictions and uncover new drug targets or more personalized medicine approaches for combating bacterial infections, the genome of the bacteria would require a large number of mutations. Hospital-associated infections (HAIs) caused by antibiotic-resistant bacteria are a major clinical problem with significant human and economic costs [6; 7]. Surgical site infections (SSIs), often caused by skin-dwelling microorganisms, make up 20% of all HAI cases and add up to USD 10 billion annually in U.S. healthcare costs by extending hospital stays [8]. Current treatments for infected wounds, such as negative pressure therapy and surgical debridement, are costly, invasive, and often harmful [9; 10]. Topical antibiotics, though widely used, face controversy due to limited evidence of efficacy and rising antibiotic resistance [6; 7; 10]. However, topical antimicrobial treatments are advantageous because they deliver high concentrations of the active agent directly to the infection site [11]. To address antimicrobial resistance, research has focused on new therapeutic combinations. The selection of appropriate materials for wound dressings is critical for wound healing. An ideal dressing should be biocompatible, non-toxic to skin cells, infection-preventive, and cost-effective [10; 12]. Recently, medicated dressings with metal and metal-oxide nanoparticles (NPs) have emerged as alternative antimicrobial agents due to their high biocompatibility and bacterial-killing efficiency [6]. NPs are less likely to develop resistance compared to classical antibiotics because their bactericidal activity targets multiple mechanisms [13; 14]. Although the exact mechanisms are not fully understood, the primary lethal factor is thought to be the excessive production of reactive oxygen species (ROSs) on their surface factor [10]. Silver nanoparticles (Ag-NPs) have been widely researched and used in biomedical devices like functionalized fiber dressings and impregnated hydrogels. However, Ag-NPs tend to aggregate, reducing their biofilm penetration effectiveness, and they can be toxic to human cells over long-term use [14; 15]. Additionally, the extensive use of Ag-NPs in industries like food and agriculture raises concerns about potential bacterial resistance [16; 17]. Zinc oxide (ZnO) nanoparticles are a promising alternative, offering similar bactericidal properties to Ag-NPs.