Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI)

Abstract

BackgroundSurgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications.ObjectivesThis study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure.MethodsAs a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups.ResultsZone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for palmitate coatings and sustaining integrity of coated sutures. Adherent S. aureus were found via SEM on all types of investigated sutures. The novel antimicrobial sutures showed significantly less viable adhered S. aureus bacteria (up to 6.1 log) compared to Vicryl® Plus (0.5 log). Within 11 μg/cm drug-containing sutures, octenidine-palmitate (OL11) showed the highest number of viable adhered S. aureus (0.5 log), similar to Vicryl® Plus. Chlorhexidine-laurate (CL11) showed the lowest number of S. aureus on sutures (1.7 log), a 1.2 log greater reduction. In addition, planktonic S. aureus in suspensions were highly inhibited by CL11 (0.9 log) represents a 0.6 log greater reduction compared to Vicryl® Plus (0.3 log).ConclusionsNovel antimicrobial sutures can potentially limit surgical site infections caused by multiple pathogenic bacterial species. Therefore, a potential inhibition of multispecies biofilm formation is assumed. In detail tested with S. aureus, the chlorhexidine-laurate coating (CL11) best meets the medical requirements f...

Sutures modified by incorporation of chlorhexidine and cinnamaldehyde: anti-Candida effect, bioavailability and mechanical properties

“…Regarding bioavailability, chlorhexidine and cinnamaldehyde were absorbed by the sutures and released gradually at low concentrations over 48 hours. Similar results on the kinetics of progressive release are demonstrated in the literature only for chlorhexidine for 48 hours 15,16 . This time is strategic for antimicrobial sutures that impede the infectious process without selecting resistant microorganisms 3 .…”

“…This time is strategic for antimicrobial sutures that impede the infectious process without selecting resistant microorganisms 3 . The low concentrations of the released substances may be, according to cell viability studies 15,16,25 , considered to be biocompatible with oral tissues for chlorhexidine and cinnamaldehy because they are below 11 μg/cm and 65 μg/mL, respectively. This is a relevant finding in this study because it demonstrates the possibility of incorporation of controlled release antimicrobials with low concentration for long times through this coating technique.…”

“…In addition, many studies have proposed various methods to develop antimicrobial sutures by using antimicrobial agents 15,16 . Cinnamaldehyde (C 9 H 8 O), a phytoconstituent extracted from cinnamon essential oil, has demonstrated antibacterial and antifungal effects in previous studies with cell viability assays 17,18 and reduced cytotoxicity in epithelial models of oral mucosa 9 .…”

Development of a Novel Polymer-Based mRNA Coating for Surgical Suture to Enhance Wound Healing

“…The development of coatings for surgical suture, until now, was mostly targeted at antimicrobial characteristics to prevent surgical site infections using antiseptic agents such as chlorhexidine, natural products such as totarol, or different kinds of silver nanoparticles [28][29][30]. Additionally, several kinds of drug-eluting sutures have been produced by a variety of manufacturing processes [31].…”

Avaliação da eficácia de agentes fí­sicos e químicos contra biofilmes produzidos por clones de bactérias multirresistentes de importância clínica e epidemiológica no Brasil

“…Através da técnica de microscopia eletrônica de varredura, alguns trabalhos têm demonstrado a presença da matriz de exopolissacarídeos decorrente ao crescimento em biofilme de diversas bactérias como E. coli (ADATOR et al, 2018;MOSHARAF et al, 2018), P. aeruginosa (PINGLE et al, 2018;POWELL et al, 2018), K. pneumoniae (MOSHARAF et al, 2018;BANDEIRA et al, 2017) e S. aureus (RUBINi et al, 2018;OBERMEIER et al, 2018).…”