Plant Extracts as Antibacterial and Antifungal Agents in Medical Textiles: A Systematic Review of Key Components, Efficacy, and Application Techniques

This systematic review examines the use of plant-derived extracts as antibacterial and antifungal agents in medical textiles, with an emphasis on active components, extraction techniques, biological efficacy, target microorganisms, and fabric application methods. This study is framed within the context of natural resource-based plant biomass and agro-industrial residues as a sustainable source of high-value functional compounds for resource valorization. Searches in Scopus and Web of Science followed the PIOC framework and PRISMA protocol. From an initial 389 records, 38 studies met the eligibility criteria. We identified a sustained growth in publications between 2020 and 2025, and six predominant thematic lines related to medical textiles, sustainability, antimicrobial assessment, structural characterization, natural dyeing optimization, and antioxidant functionalization. Among the most studied species, Aloe barbadensis and Salvia officinalis were prominent. Leaves were the most frequently used plant organ, highlighting their relevance as readily available renewable biomass resources. Maceration was the most common extraction method, although ultrasound-assisted extraction yielded a broader metabolite profile and better preserved thermolabile compounds, demonstrating the impact of biomass conversion techniques on resource efficiency and extract quality. Cotton 100% (plain weave) was the most widely used substrate, and the exhaustion method (immersion/exhaust dyeing) was the preferred application technique. Overall, plant extracts obtained through the sustainable management and valorization of plant resources achieved high inhibition against pathogenic bacteria, including resistant strains, and consistent antifungal activity, supporting their potential for developing functional and sustainable medical textiles. These findings align with the goals for responsible production and good health and well-being and reinforce the role of biomass-based resource systems within a circular bioeconomy, opening avenues to optimize formulations, standardize methodologies, and evaluate post-laundering performance and in vivo biocompatibility.