Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures

Dhom, Jonas; Bloes, Dominik Alexander; Peschel, Andreas; Hofmann, Ulf Krister

doi:10.1002/jor.23305

Cited by 57 publications

(34 citation statements)

References 53 publications

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“…While this characteristic lends itself to an improved suture-tissue interface and pull-through resistance, the broadened shape and subsequent increased surface area of FiberTape may also portend increased surgical complications, such as infection. Previous studies have demonstrated the increased bacterial adherence of braided versus monofilament sutures, 6,14 and we have shown that this also applies to increased surface area of otherwise similarly composed high–tensile strength sutures. In addition to an increased risk of acquiring an infection in the presence of bacteria (group 1), our findings suggest that FiberTape has an increased risk of retaining infection even after simulated washout procedures (groups 2 and 3).…”

Section: Discussionsupporting

confidence: 67%

FiberWire vs FiberTape: Comparison of Bacterial Adherence in a Murine Air Pouch Wound Model

Blumenthal

Bou‐Akl

Rossi

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: For high–tensile strength sutures, past research has largely focused on mechanical properties or bacterial adherence across various manufacturers. Purpose: This study investigated high-tensile strength sutures with different shapes but otherwise identical composition. The purpose was to evaluate the differences between high–tensile strength suture wire and suture tape relative to bacterial adherence and bacterial retention after washout. Study Design: Controlled laboratory study. Methods: Sutures were implanted in dorsal air pouches of 72 BALB/cJ mice. Experimental pouches were inoculated with Staphylococcus aureus; no bacteria were used in the control conditions. The mice were randomized into 3 groups: group 1 underwent suture extraction 7 days after implantation; group 2 underwent an irrigation procedure, followed by immediate suture extraction on day 7; and group 3 underwent an irrigation procedure on day 7, with delayed suture extraction on day 14 after implantation. The sutures were evaluated using confocal microscopy; electron microscopy; and spectrophotometry, through which optical density, as measured by the amount of scattered light, is directly correlated with the number of bacteria. Histological assessment was performed on the pouches. Results: Optical density (mean ± SD) was significantly higher for FiberTape sutures than for FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.0550 ± 0.0081 vs 0.0162 ± 0.006 [ P = .0054]; group 2, 0.0225 ± 0.0049 vs 0.0056 ± 0.0006 [ P = .0045]; group 3, 0.055 ± 0.0222 vs 0.0043 ± 0.0005 [ P = .0103]). Additionally, groups 2 and 3 showed statistically significant results at the 4-hour time points (group 2, 0.0384 ± 0.0087 vs 0.0145 ± 0.0042 [ P = .0280]; group 3, 0.0532 ± 0.0159 vs 0.0101 ± 0.0025 [ P = .0058]). The wash fluid also demonstrated significantly greater optical density for the FiberTape than the FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.1657 ± 0.0319 vs 0.0317 ± 0.008 [ P = .0063]; group 2, 0.0522 ± 0.0156 vs 0.0127 ± 0.0022 [ P = .0219]; group 3, 0.1707 ± 0.0205 vs 0.0191 ± 0.0053 [ P < .0001]). No bacterial growth occurred in the control conditions. Histological assessment revealed only mild inflammation in the control groups as compared with more severe responses in the experimental groups at all time points. Conclusion: FiberTape was associated with increased bacterial adhesion as well as retention as compared with FiberWire in an in vivo murine wound model. Clinical Relevance: This study demonstrates that suture design influences the occurrence of and ability to clear surgical infection and must be considered when selecting high-tensile strength sutures in a clinical setting.

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Section: Discussionsupporting

confidence: 67%

FiberWire vs FiberTape: Comparison of Bacterial Adherence in a Murine Air Pouch Wound Model

Blumenthal

Bou‐Akl

Rossi

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The role of suture material as a contributing factor to SSIs has been the subject of research since the 1970s [69]. The suture structural parameters are a crucial parameter that influences the adhesion of bacteria, and roughness on a nanoscale has been shown to be beneficial for pathogen adhesion to biomedical material [70]. The morphology of silk surgical threads can promote bacterial accumulation between the grooves of its multifilament thread, enhancing the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Natural Cellulose Fibers for Surgical Suture Applications

et al. 2020

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Suture biomaterials are critical in wound repair by providing support to the healing of different tissues including vascular surgery, hemostasis, and plastic surgery. Important properties of a suture material include physical properties, handling characteristics, and biological response for successful performance. However, bacteria can bind to sutures and become a source of infection. For this reason, there is a need for new biomaterials for suture with antifouling properties. Here we report two types of cellulose fibers from coconut (Cocos nucifera) and sisal (Agave sisalana), which were purified with a chemical method, characterized, and tested in vitro and in vivo. According to SEM images, the cellulose fiber from coconut has a porous surface, and sisal has a uniform structure without internal spaces. It was found that the cellulose fiber from sisal has mechanical properties closer to silk fiber biomaterial using Ultimate Tensile Strength. When evaluating the cellulose fibers biodegradability, the cellulose from coconut showed a rapid weight loss compared to sisal. The antifouling test was negative, which demonstrated that neither possesses intrinsic microbicidal activity. Yet, a weak biofilm was formed on sisal cellulose fibers suggesting it possesses antifouling properties compared to cellulose from coconut. In vivo experiments using healthy mice demonstrated that the scarring and mechanical connection was like silk for both cellulose fibers. Overall, our results showed the potential use of cellulose fibers from vegetal for surgical sutures due to excellent mechanical properties, rapid degradation, and no bacterial adhesion.

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“…The interesting aspect is that TIAB explicates its antibacterial and antibiofilm activity even when complexed with other components in the form of cream, providing that this combination does not inhibit its efficacy. In addition, no differences in the biofilm formation were registered on the three different braided multifilament sutures, thus confirming the broad MD versatility after surgery, as demonstrated for triclosan-coated sutures [27].…”

Section: Resultsmentioning

confidence: 57%

The Antibiofilm Effect of a Medical Device Containing TIAB on Microorganisms Associated with Surgical Site Infection

et al. 2019

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Surgical site infections (SSIs) represent the most common nosocomial infections, and surgical sutures are optimal surfaces for bacterial adhesion and biofilm formation. Staphylococcus spp., Enterococcus spp., and Escherichia coli are the most commonly isolated microorganisms. The aim of this research was to evaluate the antibiofilm activity of a medical device (MD) containing TIAB, which is a silver-nanotech patented product. The antibacterial effect was evaluated against Staphylococcus aureus ATCC 29213, Enterococcus faecalis ATCC 29212, and E. coli ATCC 25922 by assessing the minimum inhibitory concentration (MIC) by the Alamar Blue® (AB) assay. The antibiofilm effect was determined by evaluation of the minimum biofilm inhibitory concentration (MBIC) and colony-forming unit (CFU) count. Subsequently, the MD was applied on sutures exposed to the bacterial species. The antimicrobial and antibiofilm effects were evaluated by the agar diffusion test method, confocal laser scanning microscopy (CLSM), and scanning electron microscopy (SEM). The MIC was determined for S. aureus and E. faecalis at 2 mg/mL, while the MBIC was 1.5 mg/mL for S. aureus and 1 mg/mL for E. faecalis. The formation of an inhibition zone around three different treated sutures confirmed the antimicrobial activity, while the SEM and CLSM analysis performed on the MD-treated sutures underlined the presence of a few adhesive cells, which were for the most part dead. The MD showed antimicrobial and antibiofilm activities versus S. aureus and E. faecalis, but a lower efficacy against E. coli. Surgical sutures coated with the MD have the potential to reduce SSIs as well as the risk of biofilm formation post-surgery.

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Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament, braided, and barbed sutures

Cited by 57 publications

References 53 publications

FiberWire vs FiberTape: Comparison of Bacterial Adherence in a Murine Air Pouch Wound Model

FiberWire vs FiberTape: Comparison of Bacterial Adherence in a Murine Air Pouch Wound Model

Natural Cellulose Fibers for Surgical Suture Applications

The Antibiofilm Effect of a Medical Device Containing TIAB on Microorganisms Associated with Surgical Site Infection

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