Development of silver nano-coatings on silk sutures as a novel approach against surgical infections

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections

BACKGROUND

Infections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections.

METHODS

The braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans.

RESULTS

The surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures.

CONCLUSION

The coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

Drug eluting protein and polysaccharides-based biofunctionalized fabric textiles- pioneering a new frontier in tissue engineering: An extensive review

In the ever-evolving landscape of tissue engineering, medicated biotextiles have emerged as a game-changer. These remarkable textiles have garnered significant attention for their ability to craft tissue scaffolds that closely mimic the properties of natural tissues. This comprehensive review delves into the realm of medicated protein and polysaccharide-based biotextiles, exploring a diverse array of fabric materials. We unravel the intricate web of fabrication methods, ranging from weft/warp knitting to plain/stain weaving and braiding, each lending its unique touch to the world of biotextiles creation. Fibre production techniques, such as melt spinning, wet/gel spinning, and multicomponent spinning, are demystified to shed light on the magic behind these ground-breaking textiles. The biotextiles thus crafted exhibit exceptional physical and chemical properties that hold immense promise in the field of tissue engineering (TE). Our review underscores the myriad applications of drug-eluting protein and polysaccharide-based textiles, including TE, tissue repair, regeneration, and wound healing. Additionally, we delve into commercially available products that harness the potential of medicated biotextiles, paving the way for a brighter future in healthcare and regenerative medicine. Step into the world of innovation with medicated biotextiles-where science meets the art of healing.

Selected strategies to fight pathogenic bacteria

Natural products and analogues are a source of antibacterial drug discovery. Considering drug resistance levels emerging for antibiotics, identification of bacterial metalloenzymes and the synthesis of selective inhibitors are interesting for antibacterial agent development. Peptide nucleic acids are attractive antisense and antigene agents representing a novel strategy to target pathogens due to their unique mechanism of action. Antisense inhibition and development of antisense peptide nucleic acids is a new approach to antibacterial agents. Due to the increased resistance of biofilms to antibiotics, alternative therapeutic options are necessary. To develop antimicrobial strategies, optimised in vitro and in vivo models are needed. In vivo models to study biofilm-related respiratory infections, device-related infections: ventilator-associated pneumonia, tissue-related infections: chronic infection models based on alginate or agar beads, methods to battle biofilm-related infections are discussed. Drug delivery in case of antibacterials often is a serious issue therefore this review includes overview of drug delivery nanosystems.

Design and fabrication of a magnetic nanobiocomposite based on flaxseed mucilage hydrogel and silk fibroin for biomedical and in-vitro hyperthermia applications

In this research work, a magnetic nanobiocomposite is designed and presented based on the extraction of flaxseed mucilage hydrogel, silk fibroin (SF), and Fe3O4 magnetic nanoparticles (Fe3O4 MNPs). The physiochemical features of magnetic flaxseed mucilage hydrogel/SF nanobiocomposite are evaluated by FT-IR, EDX, FE-SEM, TEM, XRD, VSM, and TG technical analyses. In addition to chemical characterization, given its natural-based composition, the in-vitro cytotoxicity and hemolysis assays are studied and the results are considerable. Following the use of highest concentration of magnetic flaxseed mucilage hydrogel/SF nanobiocomposite (1.75 mg/mL) and the cell viability percentage of two different cell lines including normal HEK293T cells (95.73%, 96.19%) and breast cancer BT549 cells (87.32%, 86.9%) in 2 and 3 days, it can be inferred that this magnetic nanobiocomposite is biocompatible with HEK293T cells and can inhibit the growth of BT549 cell lines. Besides, observing less than 5% of hemolytic effect can confirm its hemocompatibility. Furthermore, the high specific absorption rate value (107.8 W/g) at 200 kHz is generated by a determined concentration of this nanobiocomposite (1 mg/mL). According to these biological assays, this magnetic responsive cytocompatible composite can be contemplated as a high-potent substrate for further biomedical applications like magnetic hyperthermia treatment and tissue engineering.

Guanidine-containing double-network silks with enhanced tensile and antibacterial property

The bacterial infection of surgical wounds results in prolonged hospitalization and even death of patients, calling for antibacterial function in modern suture products. To tackle this challenge, cationic guanidine-containing copolymer was synthesized, exhibiting antibacterial potency over 5 log reduction against both Gram-positive S. aureus and Gram-negative E. coli. Furthermore, we developed a double-network silk suture by integrating a guanidine-containing copolymer network into the silk fibroin network. This suture exhibited biocidal activity against S. aureus and E. coli, and superior strength compared to the commercial product in both dry and wet conditions. These results may bring general benefits to public health and medical equipment sustainability.

Antimicrobial Nanomaterials as Advanced Coatings for Self-Sanitizing of Textile Clothing and Personal Protective Equipment

Controlling bioaerosols has become increasingly critical in affecting human health. Natural product treatment in the nano form is a potential method since it has lower toxicity than inorganic nanomaterials like silver nanoparticles. This research is important for the creation of a bioaerosol control system that is effective. Nanoparticles (NPs) are gradually being employed to use bacteria as a nonantibiotic substitute for treating bacterial infections. The present study looks at nanoparticles' antimicrobial properties, their method of action, their impact on drug-opposing bacteria, and the hazards connected with their operation as antimicrobial agents. The aspects that influence nanoparticle conduct in clinical settings, as well as their distinctive features and mode of action as antibacterial assistants, are thoroughly examined. Nanoparticles' action on bacterial cells is presently accepted by way of the introduction of oxidative stress induction, metal-ion release, and nonoxidative methods. Because many concurrent mechanisms of action against germs would necessitate multiple simultaneous gene modifications in the same bacterial cell for antibacterial protection to evolve, bacterial cells developing resistance to NPs is difficult. This review discusses the antimicrobial function of NPs against microbes and presents a comprehensive discussion of the bioaerosols: their origin, hazards, and their prevention. This state of the art method is dependent upon the use of personal protective gear against these bioaerosols. The benefit of the utmost significant categories of metal nanoparticles as antibacterial agents is given important consideration. The novelty of this review depends upon the antimicrobial properties of (a) silver (Ag), (b) zinc oxide (ZnO), and (c) copper oxide (CuO) nanoparticles. The value-added features of these nanoparticles are discussed, as well as their physicochemical characterization and pharmacokinetics, including the toxicological danger they pose to people. Lastly, the effective role of nanomaterials and their future in human wellness is discussed.

A Review on Antibacterial Silk Fibroin-based Biomaterials: Current State and Prospects

Bacterial contamination of biomaterials is a common problem and a serious threat to human health worldwide. Therefore, the development of multifunctional biomaterials that possess antibacterial properties and can resist infection is a continual goal for biomedical applications. Silk fibroin (SF), approved by U.S. Food and Drug Administration (FDA) as a biomaterial, is one of the most widely studied natural polymers for biomedical applications due to its unique mechanical properties, biocompatibility, tunable biodegradation, and versatile material formats. In the last decade, many methods have been employed for the development of antibacterial SF-based biomaterials (SFBs) such as physical loading or chemical functionalization of SFBs with different antibacterial agents and bio-inspired surface modifications. In this review, we first describe the current understanding of the composition and structure-properties relationship of SF as a leading-edge biomaterial. Then we demonstrate the different antibacterial agents and methods implemented for the development of bactericidal SFBs, their mechanisms of action, and different applications. We briefly address their fabrication methods, advantages, and limitations, and finally discuss the emerging technologies and future trends in this research area.

Therapeutic Applications of Antimicrobial Silver-Based Biomaterials in Dentistry

Microbial infection accounts for many dental diseases and treatment failure. Therefore, the antibacterial properties of dental biomaterials are of great importance to the long-term results of treatment. Silver-based biomaterials (AgBMs) have been widely researched as antimicrobial materials with high efficiency and relatively low toxicity. AgBMs have a broad spectrum of antimicrobial properties, including penetration of microbial cell membranes, damage to genetic material, contact killing, and dysfunction of bacterial proteins and enzymes. In particular, advances in nanotechnology have improved the application value of AgBMs. Hence, in many subspecialties of dentistry, AgBMs have been researched and employed, such as caries arresting or prevention, root canal sterilization, periodontal plaque inhibition, additives in dentures, coating of implants and anti-inflammatory material in oral and maxillofacial surgery. This paper aims to provide an overview of the application approaches of AgBMs in dentistry and present better guidance for oral antimicrobial therapy via the development of AgBMs.

Biogenic and characterizations of new silver nanoparticles stabilized with indole acetic acid derived from Azospirillum brasilense MMGH-SADAT1, their bioactivity, and histopathological assessment in rats

An Egyptian rhizobacterium Azospirillum sp. isolated from Sadat city was able to produce indole acetic acid (IAA) up to (30.59 µg/ml). The isolate was identified biochemically and by 16S rRNA sequencing which showed 99.9% similarity to Azospirillum brasilense. The new isolate has been registered in Genbank with accession number MH179119.1. Extracted IAA was used as reducing or stabilizing agent of sliver nanoparticles (AgNPs). Successful fabrication of biogenic IAA-AgNPs was confirmed by Fourier Transform Infrared Spectrophotometer (FTIR) analysis of IAA which showed absorbance peak at 3434.78 cm^-1 due to the N-H stretch of primary amines. Highly resolution Transmission Electron Microscopy (HR-TEM) showed AgNPs coating or capping with IAA in spherical shaped with size ranged from 6.01 to 44.02 nm. Energy dispersive X-ray (EDX) analysis revealed that Ag⁺ ions were attached to the surface of IAA-AgNPs particles. HR-TEM examination showed cell wall damage of Citrobacter freundii cells after exposure to IAA-AgNPs leading to cell death. In vivo results showed that C. freundii infection of rats induced significant increase in liver and kidney functions and deleterious histopathological alteration in rat's tissues. However, treatment by extracted IAA and IAA-AgNPs could normalize the biochemical and histopathological alterations occurred in infected rats. This is the first study to prove that IAA extracted from Azospirillum brasilense is a hopeful capping agent for NPs which has potential to protect against pathogenic infections, nontoxic and/or safe on rat's metabolisms.

The Action-Networks of Nanosilver: Bridging the Gap between Material and Biology

The emergence of nanosilver (silver in nanoscale shapes and their assemblies) benefits the landscape of modern healthcare; however, this brings about concerns over its safety issues associated with an ultrasmall size and high mobility. By reviewing previous reporting details about the synthesis and characterization of nanosilver and its biological responses, a gap between materials synthesis and their biomedical uses is characterized by the insufficient understanding of the interacting and interplaying nanoscale actions of silver. To improve reporting quality and advance clinical translations, it is suggested that researchers have a comprehensive recognition of the "Indications for use" before designing innovative nanosilver-based materials and an "Action-network" concept addressing the acting range and strength of those nanoscale actions is implemented. Although this discussion is specific to nanosilver, the idea of "Indications for use" centered design and synthesis is generally applicable to other biomedical nanomaterials.

Hybrid Bionanocomposite Containing Magnesium Hydroxide Nanoparticles Embedded in a Carboxymethyl Cellulose Hydrogel Plus Silk Fibroin as a Scaffold for Wound Dressing Applications

Based on the promising biomedical developments in wound healing strategies, herein, a new nanobiocomposite scaffold was designed and presented by incorporation of carboxymethyl cellulose hydrogels prepared using epichlorohydrin as a cross-linking agent (CMC hydrogel), a natural silk fibroin (SF) protein, and magnesium hydroxide nanoparticles (Mg(OH)2 NPs). Biological evaluation of the CMC hydrogel/SF/Mg(OH)2 nanobiocomposite scaffold was conducted via in vitro cell viability assays and in vivo assays, red blood cell hemolysis, and antibiofilm assays. Considering the cell viability percentage of Hu02 cells (84.5%) in the presence of the prepared nanobiocomposite after 7 days, it was indicated that this new nanoscaffold was biocompatible. The signs of excellent hemocompatibility and the high antibacterial activity were observed due to the low-point hemolytic effect (8.3%) and high-level potential in constraining the P. aeruginosa biofilm formation with a low OD value (0.13). Moreover, in vivo wound healing assay results indicated that the wound healing method was faster in mice treated with the prepared nanobiocomposite scaffold (82.29%) than the control group (75.63%) in 12 days. Apart from the structural characterization of the CMC hydrogel/SF/Mg(OH)2 nanobiocomposite through FTIR, EDX, FESEM, and TG analyses, compressive mechanical tests, contact angle, porosity, and swelling ratio studies indicated that the combination of the CMC hydrogel structure with SF protein and Mg(OH)2 NPs could significantly impact Young's modulus (from 11.34 to 10.14 MPa), tensile strength (from 299.35 to 250.78 MPa), elongation at break (12.52 to 12.84%), hydrophilicity, and water uptake capacity (92.5%).

Chitosan hydrogel/silk fibroin/Mg(OH)2 nanobiocomposite as a novel scaffold with antimicrobial activity and improved mechanical properties

Herein, a novel nanobiocomposite scaffold based on modifying synthesized cross-linked terephthaloyl thiourea-chitosan hydrogel (CTT-CS hydrogel) substrate using the extracted silk fibroin (SF) biopolymer and prepared Mg(OH)2 nanoparticles was designed and synthesized. The biological capacity of this nanobiocomposite scaffold was evaluated by cell viability method, red blood cells hemolytic and anti-biofilm assays. According to the obtained results from 3 and 7 days, the cell viability of CTT-CS/SF/Mg(OH)2 nanobiocomposite scaffold was accompanied by a considerable increment from 62.5 to 89.6% respectively. Furthermore, its low hemolytic effect (4.5%), and as well, the high anti-biofilm activity and prevention of the P. aeruginosa biofilm formation confirmed its promising hemocompatibility and antibacterial activity. Apart from the cell viability, blood biocompatibility, and antibacterial activity of CTT-CS/SF/Mg(OH)2 nanobiocomposite scaffold, its structural features were characterized using spectral and analytical techniques (FT-IR, EDX, FE-SEM and TG). As well as, given the mechanical tests, it was indicated that the addition of SF and Mg(OH)2 nanoparticles to the CTT-CS hydrogel could improve its compressive strength from 65.42 to 649.56 kPa.

Scar quality examination comparing titanium-coated suture material and non-coated suture material on flap donor sites in reconstructive surgery

Background

Wound healing and scar quality after trauma are subject to impairment through excessive wound healing, chronic wound or even surgical site infections. Optimizing the process of scar formation and skin healing is crucial in virtually all fields of medicine. In this regard, we tested the possible usage and advantages of titanium coated suture material.

Methods

We performed a prospective observational cohort study including 30 patients who underwent soft tissue reconstruction. One half of the donor flap site was sutured with titanium coated suture material, while the other half was closed with non-coated sutures. Scar quality of the donor flap site was assessed by photographs and POSAS scores on days 2–5, 14, 42, 72 and 180 postoperatively.

Results

No difference between the titanium coated sutures and non-coated sutures was seen in the POSAS assessment, neither for the patient scale at 14, 42, 72 and 180 days, nor for the observer scale on the same dates. Comorbidities like diabetes, chronic renal failure and smoking as well as the BMI of each patient affected the wound healing process to an equal degree on both sides of the suture.

Conclusions

No difference between the titanium coated and non-titanium-coated suture material was seen in the POSAS assessment in regard to scar quality and wound healing. The titanium-coated suture material can be considered to be equally as effective and safe in all qualities as the non-titanium-coated suture material, even in patients with comorbidities.

Clinical trial register This study is registered at the German Clinical Trials Register (DRKS) under the registration number DRKS00021767. (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021767)

Microstructural and Tribological Properties of a Dopamine Hydrochloride and Graphene Oxide Coating Applied to Multifilament Surgical Sutures

With the development of fine surgery and desire for low-injury methods, the frictional properties of surgical sutures are one of the crucial factors that can cause damage to tissue, especially for some fragile and sensitive human tissues such as the eyeball. In this study, dopamine hydrochloride and graphene oxide were used as external application agents to prepare a biological coating for the surface of multifilament surgical sutures. The effects of this biocoating on the surface morphology, chemical properties, mechanical properties, and tribological properties of surgical sutures were studied. The friction force and the coefficient of friction of surgical sutures penetrating through a skin substitute were evaluated using a penetration friction apparatus and a linear elastic model. The tribological mechanism of the coating on the multifilament surgical sutures was investigated according to the results of the tribological test. The results showed that there were uniform dopamine and graphene oxide films on the surface of the surgical sutures, and that the fracture strength and yield stress of the coated sutures both increased. The surface wettability of the surgical sutures was improved after the coating treatment. The friction force and the coefficient of friction of the multifilament surgical sutures with the dopamine hydrochloride and graphene oxide coating changed little compared to those of the untreated multifilament surgical sutures.

Effect of Synthesis Temperature on the Size of ZnO Nanoparticles Derived from Pineapple Peel Extract and Antibacterial Activity of ZnO-Starch Nanocomposite Films

This research investigated the effect of synthesis temperature on the size and shape of zinc oxide (ZnO) nanoparticles (NPs) synthesized using pineapple peel waste and antibacterial activity of ZnO NPs in starch films. Zinc oxide NPs synthesized at different temperatures were characterized by Fourier transform infrared spectroscopy, X-ray diffraction analysis, field-emission scanning electron microscopy, energy-dispersive X-ray spectroscopy, and transmission electron microscopy. Micrographs of ZnO NPs synthesized at 28 and 60 °C showed that synthesis temperature affected the sizes and shapes of ZnO NPs. The non-heated (28 °C) condition resulted in NPs with diameters in the range of 8-45 nm with a mixture of spherical and rod shapes, whereas the heated (60 °C) condition led to NPs with diameters in the range of 73-123 nm with flower rod shapes. The ZnO-starch nanocomposite films incorporated with 1, 3, and 5 wt.% ZnO NPs were prepared via a film casting method. The antibacterial activity of the films against Gram-positive and Gram-negative bacteria was investigated using the disc diffusion method. The results showed an increase in the inhibition zone for Gram-positive bacteria, particularly Bacillus subtilis, when the concentration of ZnO NPs incorporated in the film was increased from 1 to 5 wt.%.

"Smart" Antimicrobial Nanocomplexes with Potential to Decrease Surgical Site Infections (SSI)

The emergence of resistant pathogens is a burden on mankind and threatens the existence of our species. Natural and plant-derived antimicrobial agents need to be developed in the race against antibiotic resistance. Nanotechnology is a promising approach with a variety of products. Biosynthesized silver nanoparticles (AgNP) have good antimicrobial activity. We prepared AgNPs with trans-cinnamic acid (TCA) and povidone-iodine (PI) with increased antimicrobial activity. We synthesized also AgNPs with natural cinnamon bark extract (Cinn) in combination with PI and coated biodegradable Polyglycolic Acid (PGA) sutures with the new materials separately. These compounds (TCA-AgNP, TCA-AgNP-PI, Cinn-AgNP, and Cinn-AgNP-PI) and their dip-coated PGA sutures were tested against 10 reference strains of microorganisms and five antibiotics by zone inhibition with disc- and agar-well-diffusion methods. The new compounds TCA-AgNP-PI and Cinn-AgNP-PI are broad spectrum microbicidal agents and therefore potential coating materials for sutures to prevent Surgical Site Infections (SSI). TCA-AgNP-PI inhibits the studied pathogens stronger than Cinn-AgNP-PI in-vitro and on coated sutures. Dynamic light scattering (DLS), ultraviolet-visible spectroscopy (UV-Vis), Fourier Transform infrared spectroscopy (FT-IR), Raman, x-ray diffraction (XRD), microstructural analysis by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) confirmed the composition of TCA-AgNP-PI and Cinn-AgNP-PI. Smart solutions involving hybrid materials based on synergistic antimicrobial action have promising future perspectives to combat resistant microorganisms.

Characterization of silk sutures coated with propolis and biogenic silver nanoparticles (AgNPs); an eco-friendly solution with wound healing potential against surgical site infections (SSIs)

Background/aim

Bacterial adherence to a suture material is one of the main causes of surgical site infections. An antibacterial suture material with enhanced wound healing function may protect the surgical site from infections. Thus, the present study aimed to investigate the synergistic effect of propolis and biogenic metallic nanoparticles when combined with silk sutures for biomedical use.

Materials and methods

Silver nanoparticle (AgNP) synthesis was carried out via a microbial-mediated biological route and impregnated on propolis-loaded silk sutures using an in situ process. Silk sutures fabricated with propolis and biosynthesized AgNPs (bioAgNP-propolis-coated sutures) were intensively characterized using scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), thermogravimetric analysis (TGA), and differential scanning calorimetry (DSC). The antibacterial characteristics of the bioAgNP-propolis-coated sutures were evaluated using the agar plate method. The biocompatibility of the bioAgNP-propolis- coated sutures was evaluated using 3T3 fibroblast cells, and their wound-healing potential was also investigated.

Results

BioAgNP-propolis-coated sutures displayed potent antibacterial activity against pathogenic gram-negative and gram-positive bacteria, Escherichia coli and Staphylococcus aureus, respectively. BioAgNP-propolis-coated silk sutures were found to be biocompatible with 3T3 fibroblast cell culture. In vitro wound healing scratch assay also demonstrated that the extract of bioAgNP-propolis-coated sutures stimulated the 3T3 fibroblasts’ cell proliferation.

Conclusion

Coating the silk sutures with propolis and biogenic AgNPs gave an effective antibacterial capacity to surgical sutures besides providing biocompatibility and wound healing activity.

Antimicrobial coating of spider silk to prevent bacterial attachment on silk surgical sutures

Microbial infections from post-surgery or other medical-related procedure is a serious health problem. Nowadays, the research is focused on the development of new drug-free materials with antibacterial properties to prevent or minimize the risk of infections. Spider silk is known for its unique biomechanical properties allied with biocompatibility. Recombinant DNA technology allows to bioengineering spider silk with antimicrobial peptides (AMP). Thus, our goal was to bioengineered spider silk proteins with AMP (6mer-HNP1) as an antibacterial drug-free coating for commercial silk sutures (Perma-Hand®) for decreasing bacterial infections. Perma-Hand® sutures were coated with 6mer-HNP1 by dip coating. In vitro tests, using human fetal lung fibroblasts (MRC5), showed that coated sutures sustained cell viability, and also, the contact with red blood cells (RBCs) demonstrate blood compatibility. Also, the coatings inhibited significantly the adherence and formation of biofilm, where sutures coated with 6mer-HNP1 produced a 1.5 log reduction of Methicillin-Resistant Staphylococcus aureus (MRSA) and a 2 log reduction of Escherichia coli (E. coli) compared to the uncoated Perma-Hand® suture. The mechanical properties of Perma-Hand® sutures were not affected by the presence of bioengineered spider silk proteins. Thus, the present work demonstrated that using spider silk drug-free coatings it is possible to improve the antibacterial properties of the commercial sutures. Furthermore, a new class of drug-free sutures for reducing post-implantation infections can be developed. STATEMENT OF SIGNIFICANCE: Microbial infections from post-surgery or other medical-related procedure is a serious health problem. Developing new drug-free materials with antibacterial properties is an approach to prevent or minimize the risk of infections. Spider silk is known for its unique biomechanical properties allied with biocompatibility. Recombinant DNA technology allow to bioengineering spider silk with antimicrobial peptides (AMP). Our goal is bioengineered spider silk proteins with AMP as an antibacterial coating for silk sutures. The coatings showed exceptional antibacterial properties and maintained intrinsic mechanical features. In vitro studies showed a positive effect of the coated sutures on the cell behavior. With this new drug-free bioengineered spider silk coating is possible to develop a new class of drug-free sutures for reducing post-implantation infections.

A combined approach for the development of novel sutures with antibacterial and regenerative properties: the role of silver and silk sericin functionalization

Chronic wounds and related infections cause physical and psychological distress in patients, increased mortality, disability and high health care costs. The healing process can be delayed by several factors and in particular by the risk of infections, which can be further complicated by the increasing number of antibiotic-resistant microorganisms. New approaches in wounds management have been encouraged, aiming at preventing infections and improving wound healing. In this scenario, silver has emerged as an ideal antimicrobial agent due to its recognized efficacy against bacteria, viruses and fungi. Moreover, silk and in particular silk sericin from Bombyx mori has demonstrated excellent biological properties and can be considered a good candidate for skin tissue engineering. In this study absorbable PLGA sutures were functionalized with silk sericin and, then, they were treated with silver through an in situ photochemical deposition technology in order to develop an antibacterial and regenerative biomedical device. Morphological analysis was performed by Scanning Electron Microscopy and Energy Dispersive X-Ray Spectroscopy (SEM-EDX) in order to evaluate the presence and distribution of silver deposited on the sutures. The stability and durability of the sericin/silver coatings were tested and the results were related to both antibacterial properties and sample degradation. The biological analyses also aimed at studying the biocompatibility and wound healing properties of the device, evaluating the synergistic effect between sericin and silver.

Effects of Local Application of Nano-silver on Osteomyelitis and Soft Tissue Infections: An Experimental Study in Rats

Purpose: Bone and soft tissue infections are among the least desired complications after orthopaedic surgery. This study analysed the in vivo effects of the local application of nano-silver particles (AgNPs) [1nm = 1 billionth of a meter] in soft tissue infections. Materials-Method: An experimental osteomyelitis model was formed by inoculating both tibias of 24 rats with methicillin-resistant Staphylococcus aureus. The rats were followed without treatment for 21 days. Blood samples and tibial x-rays at day 21 confirmed the development of infection. Then, the rats were divided randomly into two groups. One group (12 rats) underwent surgical debridement and received 21 days of teicoplanin therapy. The second group had the same treatment, with the addition of local nano-silver. All of the rats were sacrificed at day 42. Blood and wound swab samples were taken and the culture results were analysed. Results: No differences were observed between the groups in healing values at pathological examination, or in changes in the number of colonies at days 21 and 42. No differences in white blood cell count (WBC) were observed between the groups before and after the treatment. Conclusion: Although in vitro studies suggest the effectiveness of AgNPs on pathogens, we found that the application of nano-silver did not make any difference when used in addition to the classical osteomyelitis treatment with antibiotics and local surgical debridement. We believe that additional in vivo studies using repeated nano-silver application could be beneficial.

Facile and Eco-Friendly Fabrication of Colored and Bioactive Silk Materials Using Silver Nanoparticles Synthesized by Two Flavonoids

Recently, there has been an increasing tendency towards the functionalization of silk using silver nanoparticles (AgNPs) to inhibit bacterial multiplication and disease spread. Considering environmental factors and sustainable development, the preparation of AgNPs using natural extracts is becoming a research hotspot. This study aims at fabricating colored and bioactive silk fabric using AgNPs synthesized by two representative flavonoids (quercetin and rutin). The effects of pH, temperature, and flavonoid concentration on the yield and particle size of AgNPs were studied. The color features and functionalities of the AgNPs-treated silk were also evaluated. The results showed that the AgNPs synthesized by quercetin were generated faster but displayed poorer size uniformity than those prepared by rutin. The as-prepared AgNPs showed good stability. The AgNPs prepared by rutin displayed a more uniform distribution on silk than those synthesized by quercetin. The antibacterial activity of AgNPs-treated silk remained over 90% against E. coli and S. aureus even after 30 washing cycles. The antioxidant activity of the treated silk gradually decreased during washing. The present research proposes a facile and eco-friendly method for the preparation of AgNPs-coated silk material using flavonoids, which can serve as hygiene-related and medical textile materials.

Preventing Surgical Site Infections Using a Natural, Biodegradable, Antibacterial Coating on Surgical Sutures

Surgical site infections (SSIs) are one of the most common nosocomial infections, which can result in serious complications after surgical interventions. Foreign materials such as implants or surgical sutures are optimal surfaces for the adherence of bacteria and subsequent colonization and biofilm formation. Due to a significant increase in antibiotic-resistant bacterial strains, naturally occurring agents exhibiting antibacterial properties have great potential in prophylactic therapies. The aim of this study was to develop a coating for surgical sutures consisting of the antibacterial substance totarol, a naturally occurring diterpenoid isolated from Podocarpustotara in combination with poly(lactide-co-glycolide acid) (PLGA) as a biodegradable drug delivery system. Hence, non-absorbable monofilament and multifilament sutures were coated with solutions containing different amounts and ratios of totarol and PLGA, resulting in a smooth, crystalline coating. Using an agar diffusion test (ADT), it became evident that the PLGA/totarol-coated sutures inhibited the growth of Staphylococcus aureus over a period of 15 days. A 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay showed that the coated sutures were not cytotoxic to murine fibroblasts. Overall, the data indicates that our innovative, biodegradable suture coating has the potential to reduce the risk of SSIs and postoperative biofilm-formation on suture material without adverse effects on tissue.

Spectroscopic Characterization and Nanosafety of Ag-Modified Antibacterial Leather and Leatherette

The development of antibacterial coatings is of great interest from both industry and the consumer's point of view. In this study, we characterized tanned leather and polyurethane leatherette, typically employed in the automotive and footwear industries, which were modified by photo-deposition of antibacterial silver nanoparticles (AgNPs). Material surface chemical composition was investigated in detail by X-ray photoelectron spectroscopy (XPS). The material's antibacterial capability was checked against Escherichia coli and Staphylococcus aureus, as representative microorganisms in cross transmissions. Due to the presence of silver in a nanostructured form, nanosafety issues were considered, as well. Ionic release in contact media, as well as whole nanoparticle release from treated materials, were quantitatively evaluated, thus providing specific information on potential product nanotoxicity, which was further investigated through cytocompatibility MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays, also after surface abrasion of the materials. The proved negligible nanoparticle release, as well as the controlled release of antibacterial ions, shed light on the materials' potentialities, in terms of both high activity and safety.

Macromolecular Conjugate and Biological Carrier Approaches for the Targeted Delivery of Antibiotics

For the past few decades, the rapid rise of antibiotic multidrug-resistance has presented a palpable threat to human health worldwide. Meanwhile, the number of novel antibiotics released to the market has been steadily declining. Therefore, it is imperative that we utilize innovative approaches for the development of antimicrobial therapies. This article will explore alternative strategies, namely drug conjugates and biological carriers for the targeted delivery of antibiotics, which are often eclipsed by their nanomedicine-based counterparts. A variety of macromolecules have been investigated as conjugate carriers, but only those most widely studied in the field of infectious diseases (e.g., proteins, peptides, antibodies) will be discussed in detail. For the latter group, blood cells, especially erythrocytes, have been successfully tested as homing carriers of antimicrobial agents. Bacteriophages have also been studied as a candidate for similar functions. Once these alternative strategies receive the amount of research interest and resources that would more accurately reflect their latent applicability, they will inevitably prove valuable in the perennial fight against antibiotic resistance.

Efficacy of silver coated surgical sutures on bacterial contamination, cellular response and wound healing

The resistance demonstrated by many microorganisms towards conventional antibiotics has stimulated the interest in alternative antimicrobial agents and in novel approaches for prevention of infections. Silver, a natural braod-spectrum antimicrobial agent known since antiquity, has been widely employed in biomedical field due to its recognized antibacterial, antifungal and antiviral properties. In this work, antibacterial silver coatings were deposited on absorbable surgical sutures through the in situ photo-chemical deposition of silver clusters. Scanning electron microscopy (SEM), Energy dispersive X-ray spectroscopy (EDX) and thermo-gravimetric analysis (TGA) were performed in order to investigate the presence and distribution of the silver clusters on the substrate. The amounts of silver deposited and released by the silver treated sutures were calculated through Inductively Coupled Plasma-Mass Spectroscopy (ICP-MS), and the results were related to the biodegradation of the material. The microbiological properties and the potential cytotoxicity of the silver-treated sutures were investigated in relation with hydrolysis experiments, in order to determine the effect of the degradation on antibacterial properties and biocompatibility.

Biobased silver nanocolloid coating on silk fibers for prevention of post-surgical wound infections

Bombyx mori silk fibers are an important biomaterial and are used in surgical sutures due to their remarkable biocompatibility. The major drawback to the application of biomaterials is the risk of bacterial invasion, leading to clinical complications. We have developed an easy and cost-effective method for fabrication of antibacterial silk fibers loaded with silver nanoparticles (AgNPs) by an in situ and ex situ process using an aqueous extract of Rhizophora apiculata leaf. Scanning electron microscopy revealed that well dispersed nanoparticles impregnated the silk fibers both in situ and ex situ. The crystalline nature of the AgNPs in the silk fibers was demonstrated by X-ray diffraction. The thermal and mechanical properties of the silk fibers were enhanced after they were impregnated with AgNPs. The silver-coated silk fibers fabricated by the in situ and ex situ method exhibited more than 90% inhibition against Pseudomonas aeruginosa and Staphylococcus aureus. Silk fibers doped with AgNPs were found to be biocompatible with 3T3 fibroblasts. The results obtained represent an important advance towards the clinical application of biocompatible AgNP-loaded silk fibers for prevention of surgical wound infections.

Coated Sutures

The addition of specific proteins or growth factors onto sutures would provide a direct application of exogenous factors to promote tissue repair. The higher levels of growth factors and cytokines may optimize the healing environment and promote tissue recovery. Despite this proposed benefit, the current orthopedic literature on the use of coated sutures is limited. Although several of the published studies investigating healing improvement by coated sutures have shown promising results, these data are only based on in vitro or small animal experiments. Recent meta-analyses have reported positive effects of triclosan-coated antimicrobial sutures in regards to reduction of surgical site complications. However, biologically coated sutures are not yet widely accepted due to several unanswered questions (concentration, release kinematics, tissue reactions, etc.) in addition to the high costs of such products. Further studies are needed to demonstrate the efficacy of coated sutures in orthopedic surgery.

Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization

Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

Alternative antimicrobial approach: nano-antimicrobial materials

Despite numerous existing potent antibiotics and other antimicrobial means, bacterial infections are still a major cause of morbidity and mortality. Moreover, the need to develop additional bactericidal means has significantly increased due to the growing concern regarding multidrug-resistant bacterial strains and biofilm associated infections. Consequently, attention has been especially devoted to new and emerging nanoparticle-based materials in the field of antimicrobial chemotherapy. The present review discusses the activities of nanoparticles as an antimicrobial means, their mode of action, nanoparticle effect on drug-resistant bacteria, and the risks attendant on their use as antibacterial agents. Factors contributing to nanoparticle performance in the clinical setting, their unique properties, and mechanism of action as antibacterial agents are discussed in detail.