1
|
Griffin L, Garren MRS, Maffe P, Ghalei S, Brisbois EJ, Handa H. Preventing Staphylococci Surgical Site Infections with a Nitric Oxide-Releasing Poly(lactic acid- co-glycolic acid) Suture Material. ACS APPLIED BIO MATERIALS 2024; 7:3086-3095. [PMID: 38652779 PMCID: PMC11110049 DOI: 10.1021/acsabm.4c00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/27/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
Of the 27 million surgeries performed in the United States each year, a reported 2.6% result in a surgical site infection (SSI), and Staphylococci species are commonly the culprit. Alternative therapies, such as nitric oxide (NO)-releasing biomaterials, are being developed to address this issue. NO is a potent antimicrobial agent with several modes of action, including oxidative and nitrosative damage, disruption of bacterial membranes, and dispersion of biofilms. For targeted antibacterial effects, NO is delivered by exogenous donor molecules, like S-nitroso-N-acetylpenicillamine (SNAP). Herein, the impregnation of SNAP into poly(lactic-co-glycolic acid) (PLGA) for SSI prevention is reported for the first time. The NO-releasing PLGA copolymer is fabricated and characterized by donor molecule loading, leaching, and the amount remaining after ethylene oxide sterilization. The swelling ratio, water uptake, static water contact angle, and tensile strength are also investigated. Furthermore, its cytocompatibility is tested against 3T3 mouse fibroblast cells, and its antimicrobial efficacy is assessed against multiple Staphylococci strains. Overall, the NO-releasing PLGA copolymer holds promise as a suture material for eradicating surgical site infections caused by Staphylococci strains. SNAP impregnation affords robust antibacterial properties while maintaining the cytocompatibility and mechanical integrity.
Collapse
Affiliation(s)
- Lauren Griffin
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Mark Richard Stephen Garren
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Patrick Maffe
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Sama Ghalei
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Elizabeth J. Brisbois
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
| | - Hitesh Handa
- School
of Chemical, Materials and Biomedical Engineering, College of Engineering, University of Georgia, Athens, Georgia 30602, United States
- Department
of Pharmaceutical and Biomedical Sciences, College of Pharmacy, University of Georgia, Athens, Georgia 30602, United States
| |
Collapse
|
2
|
Daood U, Ilyas MS, Ashraf M, Akbar M, Asif A, Khan AS, Sidhu P, Sheikh Z, Davamani F, Matinlinna J, Peters OA, Yiu C. A Novel Coated Suture Displays Antimicrobial Activity Without Compromising Structural Properties. J Oral Maxillofac Surg 2024:S0278-2391(24)00329-X. [PMID: 38830601 DOI: 10.1016/j.joms.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 05/11/2024] [Accepted: 05/11/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Treated or coated sutures promise to prevent contamination of wounds. PURPOSE The purpose of the study was to coat surgical sutures with a new quaternary ammonium silane (QAS) antimicrobial compound at two different application temperatures and then to evaluate the resulting structural, physical, mechanical, and biological properties. STUDY DESIGN, SETTING, SAMPLE In vitro and in vivo studies were conducted using male albino Wistar rats approved by the Joint Ethical Committee of IMU and Postgraduate Medical Institute, Lahore. Only suture samples, coated uniformly with verified presence of the compound and of adequate length were used. Samples which were not coated uniformly and with inadequate length or damaged were excluded. PREDICTOR VARIABLE Predictor variables were sutures with and without QAS coatings and different temperatures. Sutures were coated with QAS at 0.5 and 1.0% wt/vol using the dip coating technique and sutures with and without QAS coating were tested at 25 and 40 °C temperatures. MAIN OUTCOME VARIABLE(S) Outcome variables of structural and physico-mechanical properties of QAS-coated and non-coated sutures were measured using Fourier transform infrared spectroscopy (for structural changes), confocal laser and scanning electron (for diameter changes), and tensile strength/modulus (for mechanical testing). Biologic outcome variables were tested (bacterial viability); macrophage cultures from Wistar rats were tested (M1/M2 polarization detecting IL-6 and IL-10). Macrophage cells were analyzed with CD80+ (M1) and CD163+ (M2). Chemotaxis index was calculated as a ratio of quantitative fluorescence of cells. COVARIATES Not applicable. ANALYSES Ordinal data among groups were compared using the Wilcoxon Mann-Whitney U test along with the comparison of histological analysis using the Wilcoxon Sign-rank test (P < .05). RESULTS Fourier transform infrared spectroscopy peak at 1490 cm-1 confirmed the presence of QAS on suture's surfaces with a significant increase (P < .05) in diameter (0.99 ± 0.5-mm) and weight (0.77 ± 0.02-mg) observed for 1% QAS groups treated at 40 °C. Non-coated samples heated at 25 °C had significantly (P < .05) less diameters (0.22 ± 0.03-mm) and weights (0.26 ± 0.06-mg). Highest tensile strength/modulus was observed for 0.5% QAS-coated samples which also had significantly higher antibacterial characteristics than other sutures (P < .05). QAS-coated sutures significantly increased M1 and M2 markers. CONCLUSION AND RELEVANCE QAS coating conferred antibacterial action properties without compromising the physical and mechanical properties of the suture.
Collapse
Affiliation(s)
- Umer Daood
- Associate Professor, Head of Restorative Division, Division of Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Muhammad Sharjeel Ilyas
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan
| | - Mariam Ashraf
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan
| | - Munazza Akbar
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan
| | - Amina Asif
- Assistant Professor, Department of Oral Biology, Post Graduate Medical Institute, Lahore, Pakistan
| | - Abdul Samad Khan
- Professor, Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Preena Sidhu
- Senior Lecturer, Head of Restorative Division, Division of Restorative Dentistry, School of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Zeeshan Sheikh
- Assistant Professor, Applied Oral Sciences & Dental Clinical Sciences, Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Fabian Davamani
- Associate Professor, Division of Human Biology, Faculty of Biomedical Science, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia; Professor Applied Dental Sciences, Dental Materials Science, Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| | - Jukka Matinlinna
- Professor Applied Dental Sciences, University of Manchester, School of Dentistry, Manchester, United Kingdom; Professor, Program Convenor, Department of Endodontics, Arthur A Dugoni School of Dentistry, University of the Pacific, San Francisco
| | - Ove A Peters
- Professor, Program Convenor, The University of Queensland, Brisbane, Queensland, Australia
| | - Cynthia Yiu
- Professor, Head of Paediatric Dentistry, Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong, PR China
| |
Collapse
|
3
|
Pokorný M, Kubíčková J, Klemeš J, Medek T, Brýdl A, Pachovská M, Hanová T, Chmelař J, Velebný V. Enhancing Dental Applications: A Novel Approach for Incorporating Bioactive Substances into Textile Threads. Pharmaceutics 2023; 15:2487. [PMID: 37896247 PMCID: PMC10609678 DOI: 10.3390/pharmaceutics15102487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
In the realm of surgical and dental applications, hyaluronic acid (HA) braided threads show significant therapeutic potential due to their incorporation of pharmaceutical active ingredients. This study primarily focuses on resolving the crucial challenge of devising a deposition method that can ensure both precision and uniformity in the content of the active ingredient Octenidine dihydrochloride (OCT) within each segment of the threads. Our objective in this study was to develop a continuous deposition method for OCT onto a braided thread composed of 24 hyaluronic acid-based fibers, aiming for a specific OCT content of 0.125 µg/mm, while maintaining a maximum allowable deviation of ±15% in OCT content. The motivation behind designing this novel method stemmed from the necessity of employing a volatile solvent for the active agent. Conventional wetting methods proved unsuitable due to fluctuations in the solution's concentration during deposition, and alternative methods known to us demanded intricate technical implementations. The newly introduced method offers distinct advantages, including its online processing speed, scalability potential, and cost-efficiency of the active agent solution. Additionally, it minimizes the impact on the natural polymer thread, preserving energy by obviating the need for complete thread saturation. Our research and precise apparatus development resulted in achieving the desired thread properties, with an OCT content of (1.51 ± 0.09) µg per 12 mm thread piece. These findings not only validate the suitability of this innovative method for depositing active agents but also extend its potential applicability beyond dental care.
Collapse
Affiliation(s)
- Marek Pokorný
- R&D Department, Contipro a.s., 56102 Dolní Dobrouč, Czech Republic; (J.K.); (J.K.); (T.M.); (A.B.); (M.P.); (T.H.); (J.C.); (V.V.)
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Dresing K, Slongo T. [Surgical suture material-fundamentals]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2023; 35:298-316. [PMID: 37603082 PMCID: PMC10520208 DOI: 10.1007/s00064-023-00812-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/23/2023] [Accepted: 03/09/2023] [Indexed: 08/22/2023]
Abstract
At the end of surgical therapy, the access is closed with sutures. Surgical sutures are thus used to adapt wound edges and tissues. The task of the suture material is to hold the tissues together until healing. For patients, a cosmetically good suture is often the sign of good surgery. Different tissues and layers have different requirements regarding the suture material. The different types from monofil to polyfil, braided, from absorbable to nonabsorbable are presented. The classification of suture strengths is compared. The areas of application of different strengths and the duration until removal of the sutures for the different body regions are presented. The one-hand and two-hand techniques of surgical knots are explained in detail. The technique of suture removal is presented. In the online material, the suture materials of different composition and manufacturers can be compared.
Collapse
Affiliation(s)
- Klaus Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Theddy Slongo
- Dept. of Paediatric Surgery, University Children's Hospital, 3010, Bern, Schweiz.
| |
Collapse
|
5
|
Tokgöz M, Yarkent Ç, Köse A, Oncel SS. The potential of microalgal sources as coating materials: A case study for the development of biocompatible surgical sutures. Lett Appl Microbiol 2023; 76:ovad086. [PMID: 37516447 DOI: 10.1093/lambio/ovad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/13/2023] [Accepted: 07/28/2023] [Indexed: 07/31/2023]
Abstract
Sutures are considered as surgical materials that form excellent surfaces to integrate the postoperative parts of the body. These materials present suitable platforms for potential bacterial penetrations. Therefore, coating these biomedical materials with biocompatible compounds is seen as a potential approach to improve their properties while avoiding adverse effects. The aim of this study was to evaluate Arthrospira platensis, Haematacoccus pluvialis, Chlorella minutissima, Botyrococcus braunii, and Nostoc muscorum as potential surgical suture coating materials. Their crude extracts were absorbed into two different sutures as poly glycolic (90%)-co-lactic acid (10%) (PGLA) and poly dioxanone (PDO); then, their cytotoxic effects and antibacterial activities were examined. Both N. muscorum-coated sutures (PGLA and PDO) and A. platensis-coated (PGLA and PDO) sutures did not induce any toxic effect on L929 mouse fibroblast cells (>70% cell viability). The highest antibacterial activity against Staphylococcus aureus was achieved with N. muscorum-coated PGLA and A. platensis-coated PGLA at 11.18 ± 0.54 mm and 9.52 ± 1.15 mm, respectively. These sutures were examined by mechanical analysis, and found suitable according to ISO 10993-5. In comparison with the commercial antibacterial agent (chlorohexidine), the results proved that N. muscorum extract can be considered as the most promising suture coating material for the human applications.
Collapse
Affiliation(s)
- Merve Tokgöz
- Department of Bioengineering, Faculty of Engineering, University of Ege, Bornova, Izmir, 35100, Turkey
| | - Çağla Yarkent
- Department of Bioengineering, Faculty of Engineering, University of Ege, Bornova, Izmir, 35100, Turkey
| | - Ayşe Köse
- Department of Bioengineering, Faculty of Engineering, University of Ege, Bornova, Izmir, 35100, Turkey
| | - Suphi S Oncel
- Department of Bioengineering, Faculty of Engineering, University of Ege, Bornova, Izmir, 35100, Turkey
| |
Collapse
|
6
|
Pulat G, Muganlı Z, Ercan UK, Karaman O. Effect of antimicrobial peptide conjugated surgical sutures on multiple drug-resistant microorganisms. J Biomater Appl 2023; 37:1182-1194. [PMID: 36510770 DOI: 10.1177/08853282221145872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Surgical site infections are commonly encountered as a risk factor in clinics that increase the morbidity of a patient after a surgical operation. Surgical sutures are one of the leading factor for the formation of surgical site infections that induce bacterial colonization by their broad surface area. Current strategies to overcome with surgical site infections consist utilization of antibiotic agent coatings such as triclosan. However, the significant increase in antibiotic resistance majorly decreases their efficiency against recalcitrant pathogens such as; Pseudomonas aeruginosa and Staphylococcus aureus. Therefore, the development of a multi drug-resistant antimicrobial suture without any cytotoxic effect to combat surgical site infections is vital. Antimicrobial peptides are the first defense line which has a broad range of spectrum against Gram-positive, and Gram-negative bacteria and even viruses. In addition, antimicrobial peptides have a rapid killing mechanism which is enhanced by membrane disruption and inhibition of functional proteins in pathogens without the development of antimicrobial resistance. In the scope of the current study, the antimicrobial effect of antimicrobial peptide conjugated poly (glycolic acid-co-caprolactone) (PGCL) sutures were investigated against P. aeruginosa and methicillin-resistant S. aureus (MRSA) strains by using antimicrobial peptide sequences of KRFRIRVRV-NH2, RWRWRWRW-NH2 and their dual combination (1:1). In addition, in vitro wound scratch assays were performed to evaluate the effect of antimicrobial peptide conjugated sutures on keratinocyte cell lines. Our results indicated that antimicrobial peptide modified sutures could be a potential novel medical device to overcome surgical site infections by the superior acceleration of wound healing.
Collapse
Affiliation(s)
- Günnur Pulat
- Tissue Engineering and Regenerative Medicine Laboratory, Department of Biomedical Engineering, 226844İzmir Katip Çelebi University, İzmir, Turkey
| | - Zülal Muganlı
- Tissue Engineering and Regenerative Medicine Laboratory, Department of Biomedical Engineering, 226844İzmir Katip Çelebi University, İzmir, Turkey
| | - Utku Kürşat Ercan
- Plasma Medicine Laboratory, Department of Biomedical Engineering, 226844İzmir Katip Çelebi University, İzmir, Turkey
| | - Ozan Karaman
- Tissue Engineering and Regenerative Medicine Laboratory, Department of Biomedical Engineering, 226844İzmir Katip Çelebi University, İzmir, Turkey
| |
Collapse
|
7
|
Parikh KS, Josyula A, Inoue T, Fukunishi T, Zhang H, Omiadze R, Shi R, Yazdi Y, Hanes J, Ensign LM, Hibino N. Nanofiber-coated, tacrolimus-eluting sutures inhibit post-operative neointimal hyperplasia in rats. J Control Release 2023; 353:96-104. [PMID: 36375620 PMCID: PMC9892275 DOI: 10.1016/j.jconrel.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Post-operative complications of vascular anastomosis procedures remain a significant clinical challenge and health burden globally. Each year, millions of anastomosis procedures connect arteries and/or veins in vascular bypass, vascular access, organ transplant, and reconstructive surgeries, generally via suturing. Dysfunction of these anastomoses, primarily due to neointimal hyperplasia and the resulting narrowing of the vessel lumen, results in failure rates of up to 50% and billions of dollars in costs to the healthcare system. Non-absorbable sutures are the gold standard for vessel anastomosis; however, damage from the surgical procedure and closure itself causes an inflammatory cascade that leads to neointimal hyperplasia at the anastomosis site. Here, we demonstrate the development of a novel, scalable manufacturing system for fabrication of high strength sutures with nanofiber-based coatings composed of generally regarded as safe (GRAS) polymers and either sirolimus, tacrolimus, everolimus, or pimecrolimus. These sutures provided sufficient tensile strength for maintenance of the vascular anastomosis and sustained drug delivery at the site of the anastomosis. Tacrolimus-eluting sutures provided a significant reduction in neointimal hyperplasia in rats over a period of 14 days with similar vessel endothelialization in comparison to conventional nylon sutures. In contrast, systemically delivered tacrolimus caused significant weight loss and mortality due to toxicity. Thus, drug-eluting sutures provide a promising platform to improve the outcomes of vascular interventions without modifying the clinical workflow and without the risks associated with systemic drug delivery.
Collapse
Affiliation(s)
- Kunal S Parikh
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Center for Bioengineering Innovation & Design, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Aditya Josyula
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Takahiro Inoue
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Takuma Fukunishi
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Huaitao Zhang
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Revaz Omiadze
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Richard Shi
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Youseph Yazdi
- Center for Bioengineering Innovation & Design, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Justin Hanes
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD 21231, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA.
| | - Laura M Ensign
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD 21231, USA; Department of Gynecology and Obstetrics and Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
| | - Narutoshi Hibino
- Department of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; Department of Cardiac Surgery, University of Chicago/Advocate Children's Hospital, Chicago, IL 60637, USA.
| |
Collapse
|
8
|
Meoli A, Ciavola L, Rahman S, Masetti M, Toschetti T, Morini R, Dal Canto G, Auriti C, Caminiti C, Castagnola E, Conti G, Donà D, Galli L, La Grutta S, Lancella L, Lima M, Lo Vecchio A, Pelizzo G, Petrosillo N, Simonini A, Venturini E, Caramelli F, Gargiulo GD, Sesenna E, Sgarzani R, Vicini C, Zucchelli M, Mosca F, Staiano A, Principi N, Esposito S. Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention. Antibiotics (Basel) 2022; 11:antibiotics11070863. [PMID: 35884117 PMCID: PMC9311619 DOI: 10.3390/antibiotics11070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 12/04/2022] Open
Abstract
A surgical site infection (SSI) is an infection that occurs in the incision created by an invasive surgical procedure. Although most infections are treatable with antibiotics, SSIs remain a significant cause of morbidity and mortality after surgery and have a significant economic impact on health systems. Preventive measures are essential to decrease the incidence of SSIs and antibiotic abuse, but data in the literature regarding risk factors for SSIs in the pediatric age group are scarce, and current guidelines for the prevention of the risk of developing SSIs are mainly focused on the adult population. This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children. The specific scenarios developed are intended to guide the healthcare professional in practice to ensure standardized management of the neonatal and pediatric patients, decrease the incidence of SSIs and reduce antibiotic abuse.
Collapse
Affiliation(s)
- Aniello Meoli
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Lorenzo Ciavola
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Sofia Rahman
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Marco Masetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Tommaso Toschetti
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Riccardo Morini
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Giulia Dal Canto
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
| | - Cinzia Auriti
- Neonatology and Neonatal Intensive Care Unit, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Caterina Caminiti
- Research and Innovation Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Elio Castagnola
- Infectious Diseases Unit, IRCCS Giannina Gaslini, 16147 Genoa, Italy;
| | - Giorgio Conti
- Pediatric ICU and Trauma Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy;
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, 35100 Padua, Italy;
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Stefania La Grutta
- Institute of Translational Pharmacology IFT, National Research Council, 90146 Palermo, Italy;
| | - Laura Lancella
- Paediatric Infectious Disease Unit, Academic Department of Pediatrics, IRCCS Bambino Gesù Children’s Hospital, 00165 Rome, Italy;
| | - Mario Lima
- Pediatric Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Lo Vecchio
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | - Gloria Pelizzo
- Pediatric Surgery Department, “Vittore Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Nicola Petrosillo
- Infection Prevention and Control—Infectious Disease Service, Foundation University Hospital Campus Bio-Medico, 00128 Rome, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60123 Ancona, Italy;
| | - Elisabetta Venturini
- Infectious Disease Unit, Meyer Children’s Hospital, 50139 Florence, Italy; (L.G.); (E.V.)
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Gaetano Domenico Gargiulo
- Department of Cardio-Thoracic and Vascular Medicine, Adult Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Enrico Sesenna
- Maxillo-Facial Surgery Unit, Head and Neck Department, University Hospital of Parma, 43126 Parma, Italy;
| | - Rossella Sgarzani
- Servizio di Chirurgia Plastica, Centro Grandi Ustionati, Ospedale M. Bufalini, AUSL Romagna, 47521 Cesena, Italy;
| | - Claudio Vicini
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Morgagni Piertoni Hospital, 47121 Forli, Italy;
| | - Mino Zucchelli
- Pediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy;
| | - Fabio Mosca
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Mother, Child and Infant, 20122 Milan, Italy;
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, 80138 Naples, Italy; (A.L.V.); (A.S.)
| | | | - Susanna Esposito
- Pediatric Clinic, University Hospital, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (A.M.); (L.C.); (S.R.); (M.M.); (T.T.); (R.M.); (G.D.C.)
- Correspondence: ; Tel.: +39-0521-903524
| | | |
Collapse
|
9
|
Deng X, Gould M, Ali MA. A review of current advancements for wound healing: Biomaterial applications and medical devices. J Biomed Mater Res B Appl Biomater 2022; 110:2542-2573. [PMID: 35579269 PMCID: PMC9544096 DOI: 10.1002/jbm.b.35086] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 12/12/2022]
Abstract
Wound healing is a complex process that is critical in restoring the skin's barrier function. This process can be interrupted by numerous diseases resulting in chronic wounds that represent a major medical burden. Such wounds fail to follow the stages of healing and are often complicated by a pro‐inflammatory milieu attributed to increased proteinases, hypoxia, and bacterial accumulation. The comprehensive treatment of chronic wounds is still regarded as a significant unmet medical need due to the complex symptoms caused by the metabolic disorder of the wound microenvironment. As a result, several advanced medical devices, such as wound dressings, wearable wound monitors, negative pressure wound therapy devices, and surgical sutures, have been developed to correct the chronic wound environment and achieve skin tissue regeneration. Most medical devices encompass a wide range of products containing natural (e.g., chitosan, keratin, casein, collagen, hyaluronic acid, alginate, and silk fibroin) and synthetic (e.g., polyvinyl alcohol, polyethylene glycol, poly[lactic‐co‐glycolic acid], polycaprolactone, polylactic acid) polymers, as well as bioactive molecules (e.g., chemical drugs, silver, growth factors, stem cells, and plant compounds). This review addresses these medical devices with a focus on biomaterials and applications, aiming to deliver a critical theoretical reference for further research on chronic wound healing.
Collapse
Affiliation(s)
- Xiaoxuan Deng
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Maree Gould
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Azam Ali
- Centre for Bioengineering & Nanomedicine (Dunedin), Department of Oral Rehabilitation, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| |
Collapse
|
10
|
Contact Dermatitis in the Surgical Patient: A Focus on Wound Closure Materials. Dermatitis 2022; 34:191-200. [PMID: 35481860 DOI: 10.1097/der.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Irritant and allergic contact dermatitis from wound closure materials can occur in patients after surgical procedures. The resulting inflammation from contact dermatitis can compromise wound healing, mimic surgical site infections, and result in wound dehiscence. Components of wound closure material, such as antibiotic coatings, dyes, sterilizing compounds, or the material itself, have been implicated as contact allergens. This article provides the latest overview of the components of 3 major forms of wound closure materials-sutures, staples, and tissue adhesives-associated with contact dermatitis, discusses their cross-reactivity, and provides diagnostic and treatment guidelines.
Collapse
|
11
|
Daoud FC, Goncalves R, Moore N. How Long Do Implanted Triclosan Sutures Inhibit Staphylococcus aureus in Surgical Conditions? A Pharmacological Model. Pharmaceutics 2022; 14:pharmaceutics14030539. [PMID: 35335916 PMCID: PMC8953209 DOI: 10.3390/pharmaceutics14030539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Sutures with triclosan (TS) are used to reduce the risk of surgical site infections (SSI), but most clinical trials are inconclusive. The traceability of SSI risk to antimicrobial activity in operated tissues is needed. (2) Objectives: This study aimed to predict triclosan antistaphylococcal activity in operated tissues. (3) Methods: Three TS were exposed to static water for 30 days, and triclosan release was recorded. Polyglactin TS explanted from sheep seven days after cardiac surgery according to 3Rs provided ex vivo acceleration benchmarks. TS immersion up to 7 days in ethanol-water cosolvency and stirring simulated tissue implantation. Controls were 30-day immersion in static water. The release rate over time was measured and fitted to a predictive function. Antistaphylococcal activity and duration were measured by time-kill analysis with pre-immersed polyglactin TS. (4) Fifteen to 60-fold accelerated in vitro conditions reproduced the benchmarks. The rate prediction with double-exponential decay was validated. The antistaphylococcal activity was bactericidal, with TS pre-immersed for less than 12 h before then S. aureus began to grow. The residual triclosan level was more than 95% and played no detectable role. (5) Conclusions: Polyglactin, poliglecaprone, and polydioxanone TS share similar triclosan release functions with parametric differences. Polyglactin TS is antistaphylococcal in surgical conditions for 4 to 12 h.
Collapse
Affiliation(s)
- Frederic Christopher Daoud
- INSERM U1219, Bordeaux Population Health, Bordeaux University, 146 rue Léo Saignat, CEDEX, F-33076 Bordeaux, France; (R.G.); (N.M.)
- Correspondence: or ; Tel.: +33-(0)6-0300-6898
| | - Ruben Goncalves
- INSERM U1219, Bordeaux Population Health, Bordeaux University, 146 rue Léo Saignat, CEDEX, F-33076 Bordeaux, France; (R.G.); (N.M.)
- CHU de Bordeaux, Laboratoire de Pharmacologie et Toxicologie, Place Amélie Raba Léon, CEDEX, F-33076 Bordeaux, France
| | - Nicholas Moore
- INSERM U1219, Bordeaux Population Health, Bordeaux University, 146 rue Léo Saignat, CEDEX, F-33076 Bordeaux, France; (R.G.); (N.M.)
| |
Collapse
|
12
|
Parikh KS, Omiadze R, Josyula A, Shi R, Anders NM, He P, Yazdi Y, McDonnell PJ, Ensign LM, Hanes J. Ultra-thin, high strength, antibiotic-eluting sutures for prevention of ophthalmic infection. Bioeng Transl Med 2021; 6:e10204. [PMID: 34027091 PMCID: PMC8126818 DOI: 10.1002/btm2.10204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 11/17/2022] Open
Abstract
Sutures are applied almost universally at the site of trauma or surgery, making them an ideal platform to modulate the local, postoperative biological response, and improve surgical outcomes. To date, the only globally marketed drug-eluting sutures are coated with triclosan for antibacterial application in general surgery. Loading drug directly into the suture rather than coating the surface offers the potential to provide drug delivery functionality to microsurgical sutures and achieve sustained drug delivery without increasing suture thickness. However, conventional methods for drug incorporation directly into the suture adversely affect breaking strength. Thus, there are no market offerings for drug-eluting sutures, drug-coated, or otherwise, in ophthalmology, where very thin sutures are required. Sutures themselves help facilitate bacterial infection, and antibiotic eye drops are commonly prescribed to prevent infection after ocular surgeries. An antibiotic-eluting suture may prevent bacterial colonization of sutures and preclude patient compliance issues with eye drops. We report twisting of hundreds of individual drug-loaded, electrospun nanofibers into a single, ultra-thin, multifilament suture capable of meeting both size and strength requirements for microsurgical ocular procedures. Nanofiber-based polycaprolactone sutures demonstrated no loss in strength with loading of 8% levofloxacin, unlike monofilament sutures which lost more than 50% strength. Moreover, nanofiber-based sutures retained strength with loading of a broad range of drugs, provided antibiotic delivery for 30 days in rat eyes, and prevented ocular infection in a rat model of bacterial keratitis.
Collapse
Affiliation(s)
- Kunal S. Parikh
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Revaz Omiadze
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Aditya Josyula
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Richard Shi
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nicole M. Anders
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ping He
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Youseph Yazdi
- Center for Bioengineering Innovation & DesignJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Peter J. McDonnell
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Laura M. Ensign
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Justin Hanes
- Center for NanomedicineThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of OphthalmologyThe Wilmer Eye Institute, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Biomedical EngineeringJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Chemical and Biomolecular EngineeringJohns Hopkins UniversityBaltimoreMarylandUSA
- Department of OncologySidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
13
|
Eidmann A, Ewald A, Boelch SP, Rudert M, Holzapfel BM, Stratos I. In vitro evaluation of antibacterial efficacy of vancomycin-loaded suture tapes and cerclage wires. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:42. [PMID: 33825078 PMCID: PMC8024230 DOI: 10.1007/s10856-021-06513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/16/2021] [Indexed: 05/10/2023]
Abstract
Usage of implants containing antibiotic agents has been a common strategy to prevent implant related infections in orthopedic surgery. Unfortunately, most implants with microbial repellent properties are characterized by accessibility limitations during daily clinical practice. Aim of this in vitro study was to investigate whether suture tapes and cerclage wires, which were treated with vancomycin, show a sustainable antibacterial activity. For this purpose, we used 24 stainless steel wire cerclages and 24 ultra-high molecular weight polyethylene and polyester suture tape test bodies. The test bodies were incubated for 30 min. in 100 mg/ml vancomycin solution or equivalent volumes of 0.9% NaCl. After measuring the initial solution uptake of the test bodies, antibacterial efficacy via agar diffusion test with Staphylococcus aureus and vancomycin elution tests were performed 1, 2, 3, and 6 days after incubation. Vancomycin-loaded tapes as well as vancomycin-loaded cerclage wires demonstrated increased bacterial growth inhibition when compared to NaCl-treated controls. Vancomycin-loaded tapes showed an additional twofold and eightfold increase of bacterial growth inhibition compared to vancomycin-loaded wires at day 1 and 2, respectively. Elution tests at day 1 revealed high levels of vancomycin concentration in vancomycin loaded tapes and wires. Additionally, the concentration in vancomycin loaded tapes was 14-fold higher when compared to vancomycin loaded wires. Incubating suture tapes and cerclage wires in vancomycin solution showed a good short-term antibacterial activity compared to controls. Considering the ease of vancomycin application on suture tapes or wires, our method could represent an attractive therapeutic strategy in biofilm prevention in orthopedic surgery.
Collapse
Affiliation(s)
- Annette Eidmann
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University Hospital Wuerzburg, Pleicherwall 2, 97070, Wuerzburg, Germany
| | - Sebastian P Boelch
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Boris M Holzapfel
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, Julius-Maximilians University Wuerzburg, Koenig-Ludwig-Haus, Brettreichstrasse 11, 97074, Wuerzburg, Germany.
| |
Collapse
|
14
|
Ren EJ, Guardia A, Shi T, Begeman P, Ren W, Vaidya R. A distinctive release profile of vancomycin and tobramycin from a new and injectable polymeric dicalcium phosphate dehydrate cement (P-DCPD). Biomed Mater 2021; 16:025019. [PMID: 33361554 DOI: 10.1088/1748-605x/abd689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A novel injectable polymeric dicalcium phosphate dehydrate (P-DCPD) cement was developed with superior mechanical strength and excellent cohesion. The purpose of this study was to assess the in vitro performance of P-DCPD loaded with vancomycin (VAN-P), tobramycin (TOB-P) and combination of both (VAN/TOB-P) (10%, w/w). There is a distinctive release profile between VAN and TOB. VAN-P showed decreased initial burst (<30% within 3 d) and sustained VAN release (76% in 28 d). In the presence of TOB (VAN/TOB-P), >90% of VAN was released within 3 d (p < 0.05). Slow and limited TOB release was observed both in TOB-P (<5%) and in TOB/VAN-P (<1%) over 28 d. Zone of inhibition (ZOI) of Staphylococcus aureus growth showed that eluents collected from VAN-P had stronger and longer ZOI (28 d) than that from TOB-P (14 d, p < 0.05). Direct contact of VAN-P, TOB-P and VAN/TOB-P cements displayed persistent and strong ZOI for >3 weeks. Interestingly, the cement residues (28 d after drug release) still maintained strong ZOI ability. P-DCPD with or without antibiotics loading were nontoxic and had no inferior impacts on the growth of osteoblastic MC3T3 cells. VAN-P and TOB-P were injectable. No significant influence on setting time was observed in both VAN-P (11.7 ± 1.9 min) and VAN/TOB-P (10.8 ± 1.5 min) as compared to control (12.2 ± 2.6 min). We propose that a distinctive release profile of VAN and TOB observed is mainly due to different distribution pattern of VAN and TOB within P-DCPD matrix. A limited release of TOB might be due to the incorporation of TOB inside the crystalline lattice of P-DCPD crystals. Our data supported that the bactericidal efficacy of antibiotics-loaded P-DCPD is not only depend on the amount and velocity of antibiotics released, but also probably more on the direct contact of attached bacteria on the degrading cement surface.
Collapse
Affiliation(s)
- E J Ren
- Department of Orthopaedic Surgery, Detroit Medical Center, Detroit, MI 48201, United States of America
| | | | | | | | | | | |
Collapse
|
15
|
Alves D, Borges P, Grainha T, Rodrigues CF, Pereira MO. Tailoring the immobilization and release of chlorhexidine using dopamine chemistry to fight infections associated to orthopedic devices. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 120:111742. [PMID: 33545884 DOI: 10.1016/j.msec.2020.111742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
A crucial factor in the pathogenesis of orthopedics associated infections is that bacteria do not only colonize the implant surface but also the surrounding tissues. This study aimed to engineer an antimicrobial release coating for stainless steel (SS) surfaces, to impart them with the ability to prevent Staphylococci colonization. Chlorhexidine (CHX) was immobilized using two polydopamine (pDA)-based approaches: a one-pot synthesis, where CHX is dissolved together with dopamine before its polymerization; and a two-step methodology, comprising the deposition of a pDA layer to which CHX is immobilized. To modulate CHX release, an additional layer of pDA was also added for both strategies. Immobilization of CHX using a one-step approach yielded surfaces with a more homogenous coating and less roughness than the other strategies. The amount of released CHX was lower for the one-step approach, as opposed to the two-step approach yielding the higher release, which could be decreased by applying an outward layer of pDA. Both one and two-step approaches provided the surfaces with the ability to prevent bacterial colonization of the surface itself and kill most of bacteria in the bulk phase up to 10 days. This long-term antimicrobial performance alluded a stable and enduring immobilization of CHX. In terms of biocompatibility, the amount of CHX released from the one-step approach did not compromise the growth of mammalian cells, contrary to the two-step strategy. Additionally, the few bacteria that managed to adhere to surfaces modified with one-step approach did not show evidence of resistance towards CHX. Overall data underline that one-step immobilization of CHX holds great potential to be further applied in the fight against orthopedic devices associated infections.
Collapse
Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal.
| | - Patrick Borges
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Célia F Rodrigues
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, LIBRO - Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| |
Collapse
|
16
|
Scull G, Brown AC. Development of novel microenvironments for promoting enhanced wound healing. CURRENT TISSUE MICROENVIRONMENT REPORTS 2020; 1:73-87. [PMID: 33748773 PMCID: PMC7968354 DOI: 10.1007/s43152-020-00009-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Nonhealing wounds are a significant issue facing the healthcare industry. Materials that modulate the wound microenvironment have the potential to improve healing outcomes. RECENT FINDINGS A variety of acellular and cellular scaffolds have been developed for regulating the wound microenvironment, including materials for controlled release of antimicrobials and growth factors, materials with inherent immunomodulative properties, and novel colloidal-based scaffolds. Scaffold construction methods include electrospinning, 3D printing, decellularization of extracellular matrix, or a combination of techniques. Material application methods include layering or injecting at the wound site. SUMMARY Though these techniques show promise for repairing wounds, all material strategies thus far struggle to induce regeneration of features such as sweat glands and hair follicles. Nonetheless, innovative technologies currently in the research phase may facilitate future attainment of these features. Novel methods and materials are constantly arising for the development of microenvironments for enhanced wound healing.
Collapse
Affiliation(s)
- Grant Scull
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Ashley C. Brown
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| |
Collapse
|
17
|
Gaukroger AJ, Jones RJS, Evans JP, Dixon SM. Does skin preparation alter suture strength characteristics? Assessing the effect of chlorhexidine and isopropyl alcohol on common skin closure suture material. Int Wound J 2020; 17:1857-1862. [PMID: 32856373 DOI: 10.1111/iwj.13475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022] Open
Abstract
Sutures are essential to approximate tissues and enable healing by first intention until a wound regains its original tensile strength. The mechanical properties of sutures are well documented, but the effects of exposing sutures to skin preparation solutions used in surgery are not. This study was performed to investigate whether 2% chlorhexidine and 70% isopropyl alcohol skin preparation, commonly used prior to incision and prior to closure, has any effect on the mechanical properties of several commonly used surgical suture types. Four suture types were soaked in either 2% chlorhexidine and 70% isopropyl alcohol or Hartmann's solution for 5 minutes. All sutures were left to dry for 11 days before being tested to failure using an Instron 3367 tensile testing machine. Testing revealed significant differences in failure load, ultimate tensile stress, and Young's modulus between suture types (P < .05). No significant differences in failure load (P = .98), ultimate tensile stress (P = .21), or Young's modulus (P = .22) were observed between the test group and the control group when comparing sutures of the same type. This study demonstrates that chlorhexidine/isopropyl skin preparation solutions do not significantly change the mechanical properties of suture materials exposed to them.
Collapse
Affiliation(s)
- Andrew J Gaukroger
- Department of Orthopaedic Surgery, East Surrey Hospital, Redhill, UK.,University of Exeter Medical School, Exeter, UK
| | - Robin J S Jones
- Department of Orthopaedic Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Jonathan P Evans
- University of Exeter Medical School, Exeter, UK.,Department of Orthopaedic Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sean M Dixon
- Department of Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
| |
Collapse
|
18
|
Queiroz VM, Kling IC, Eltom AE, Archanjo BS, Prado M, Simão RA. Corn starch films as a long-term drug delivery system for chlorhexidine gluconate. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 112:110852. [DOI: 10.1016/j.msec.2020.110852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/19/2020] [Accepted: 03/13/2020] [Indexed: 11/15/2022]
|
19
|
De Simone B, Sartelli M, Coccolini F, Ball CG, Brambillasca P, Chiarugi M, Campanile FC, Nita G, Corbella D, Leppaniemi A, Boschini E, Moore EE, Biffl W, Peitzmann A, Kluger Y, Sugrue M, Fraga G, Di Saverio S, Weber D, Sakakushev B, Chiara O, Abu-Zidan FM, ten Broek R, Kirkpatrick AW, Wani I, Coimbra R, Baiocchi GL, Kelly MD, Ansaloni L, Catena F. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 2020; 15:10. [PMID: 32041636 PMCID: PMC7158095 DOI: 10.1186/s13017-020-0288-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
Collapse
Affiliation(s)
- Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Via Donatori di sangue 1, 42016 Guastalla, RE Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56124 Pisa, Italy
| | - Chad G. Ball
- Department of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta T2N 2T9 Canada
| | - Pietro Brambillasca
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, Cisanello Hospital, Pisa, Italy
| | | | - Gabriela Nita
- Unit of General Surgery, Castelnuovo ne’Monti Hospital, AUSL, Reggio Emilia, Italy
| | - Davide Corbella
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Elena Boschini
- Medical Library, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health and University of Colorado, Denver, USA
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Andrew Peitzmann
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Gustavo Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Boris Sakakushev
- University Hospital St George First, Clinic of General Surgery, Plovdiv, Bulgaria
| | - Osvaldo Chiara
- State University of Milan, Acute Care Surgery Niguarda Hospital, Milan, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Micheal D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
| |
Collapse
|
20
|
Franco AR, Fernandes EM, Rodrigues MT, Rodrigues FJ, Gomes ME, Leonor IB, Kaplan DL, Reis RL. Antimicrobial coating of spider silk to prevent bacterial attachment on silk surgical sutures. Acta Biomater 2019; 99:236-246. [PMID: 31505301 DOI: 10.1016/j.actbio.2019.09.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 02/08/2023]
Abstract
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.
Collapse
|
21
|
Dong JJ, Muszanska A, Xiang F, Falkenberg R, van de Belt-Gritter B, Loontjens T. Contact Killing of Gram-Positive and Gram-Negative Bacteria on PDMS Provided with Immobilized Hyperbranched Antibacterial Coatings. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2019; 35:14108-14116. [PMID: 31568724 PMCID: PMC6822135 DOI: 10.1021/acs.langmuir.9b02549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/20/2019] [Indexed: 05/19/2023]
Abstract
Here we describe in detail the preparation and application of antibacterial coatings on PDMS (poly(dimethylsiloxane)) and the contact-killing properties with 10 bacterial strains. Our aim was to develop a generally applicable coating to prevent biomaterial acquired infections, which is the major mode of failure of biomedical implants. In the first step, the surface was provided with a hydrophobic hyperbranched coating resin that was covalently attached to PDMS, mediated by an appropriate coupling agent. The coupling agent contained a siloxane group that reacts covalently with the silanol groups of air-plasma-treated PDMS and a blocked isocyanate enabling covalent coupling with the amino groups of the hyperbranched coating resins. The coating resins were functionalized with a polyethylenimine and subsequently quaternized with bromohexane and iodomethane. The coatings were highly effective against Gram-positive bacteria (five strains) and sufficiently active against Gram-negative bacteria (five stains). The killing effect on the latter group was strongly enhanced by adding a permeabilizer (EDTA). The biocidal efficacy was not influenced by the presence of (saliva) proteins.
Collapse
Affiliation(s)
- Jia Jia Dong
- Department
of Polymer Chemistry, Zernike Institute
for Advanced Materials, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
| | - Agnieszka Muszanska
- Department
of Biomedical Engineering, University of
Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Fei Xiang
- Department
of Polymer Chemistry, Zernike Institute
for Advanced Materials, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
| | | | - Betsy van de Belt-Gritter
- Department
of Biomedical Engineering, University of
Groningen and University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Ton Loontjens
- Department
of Polymer Chemistry, Zernike Institute
for Advanced Materials, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
- E-mail:
| |
Collapse
|
22
|
The Antibiofilm Effect of a Medical Device Containing TIAB on Microorganisms Associated with Surgical Site Infection. Molecules 2019; 24:molecules24122280. [PMID: 31248162 PMCID: PMC6630542 DOI: 10.3390/molecules24122280] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 01/21/2023] Open
Abstract
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.
Collapse
|
23
|
Ojah N, Deka J, Haloi S, Kandimalla R, Gogoi D, Medhi T, Mandal M, Ahmed GA, Choudhury AJ. Chitosan coated silk fibroin surface modified by atmospheric dielectric-barrier discharge (DBD) plasma: a mechanically robust drug release system. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:1142-1160. [DOI: 10.1080/09205063.2019.1622844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Namita Ojah
- Laboratory for Plasma Processing of Materials, Department of Physics, Tezpur University, Tezpur, Assam, India
| | - Jyotishikha Deka
- Laboratory for Plasma Processing of Materials, Department of Physics, Tezpur University, Tezpur, Assam, India
| | - Saurav Haloi
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Raghuram Kandimalla
- Drug Discovery Laboratory, Institute of Advanced study in Science and Technology, Guwahati, Assam, India
| | - Dolly Gogoi
- Central Instruments Facility, Indian Institute of Technology, Guwahati, Assam, India
| | - Tapas Medhi
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Manabendra Mandal
- Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Gazi Ameen Ahmed
- Laboratory for Plasma Processing of Materials, Department of Physics, Tezpur University, Tezpur, Assam, India
| | - Arup Jyoti Choudhury
- Laboratory for Plasma Processing of Materials, Department of Physics, Tezpur University, Tezpur, Assam, India
| |
Collapse
|
24
|
COSTA RC, CAVALCANTI YW, VALENÇA AMG, ALMEIDA LDFDD. Sutures modified by incorporation of chlorhexidine and cinnamaldehyde: anti-Candida effect, bioavailability and mechanical properties. REVISTA DE ODONTOLOGIA DA UNESP 2019. [DOI: 10.1590/1807-2577.04219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction Antimicrobial sutures are a therapeutic alternative for the control of oral infections. Objective Incorporate Chlorhexidine (CHX) and Cinnamaldehyde (CN) in sutures and evaluate the anti-Candida effect, release of antimicrobials and mechanical properties. Material and method Silk (S) and Polyglactin 910 (P) sutures were aseptically sectioned (20 mm) and immersed for incorporation in 0.12% CHX, 0.4% CN and 0.9% saline solutions under stirring for 60 minutes (n = 10 / group). Suspensions of 500 μL of Candida albicans (ATCC 90028/ 1 × 106 CFU/mL) were used to evaluate fungal adhesion after the 48 h period at 37°C. The release of CLX and CN were evaluated at 0, 24 and 48 hours (n=3/group) by UV-VIS spectrophotometer (275 nm). The tensile strength and displacement (n=5/group) were evaluated after incorporation (30 mm/min, 50N). Data were analyzed by Anova and Tukey (α = 5%). Result No anti-Candida effect was observed on S and P sutures incorporated with CLX and CN (p>0.05). However, progressive release was verified up to 48 after treatment with CLX (S = 0.075 / P = 0.073 μg/mL) and CN (S = 35.33 /P= 5.72 μg/mL). There was a decrease in tensile strength in S (CLX = 9.9 / CN = 9.9 N) and P (CLX = 14.4 / CN = 15.5 N) (p<0.05). No differences were observed for the displacement for S (CLX = 19.3 / CN=20.7 mm) and P (CLX = 16.2 / CN=15.8 mm) (p>0.05). Conclusion The incorporation of CLX and CN did not have a positive effect on the biological and mechanical properties of the sutures evaluated.
Collapse
|
25
|
Prevention of bacterial colonization on non-thermal atmospheric plasma treated surgical sutures for control and prevention of surgical site infections. PLoS One 2018; 13:e0202703. [PMID: 30183745 PMCID: PMC6124751 DOI: 10.1371/journal.pone.0202703] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/07/2018] [Indexed: 11/19/2022] Open
Abstract
Surgical site infections have a remarkable impact on morbidity, extended hospitalization and mortality. Sutures strongly contribute to development of surgical site infections as they are considered foreign material in the human body. Sutures serve as excellent surfaces for microbial adherence and subsequent colonization, biofilm formation and infection on the site of a surgery. Various antimicrobial sutures have been developed to prevent suture-mediated surgical site infection. However, depending on the site of surgery, antimicrobial sutures may remain ineffective, and antimicrobial agents on them might have drawbacks. Plasma, defined as the fourth state of matter, composed of ionized gas, reactive oxygen and nitrogen species, free radical and neutrals, draws attention for the control and prevention of hospital-acquired infections due to its excellent antimicrobial activities. In the present study, the efficacy of non-thermal atmospheric plasma treatment for prevention of surgical site infections was investigated. First, contaminated poly (glycolic-co-lactic acid), polyglycolic acid, polydioxanone and poly (glycolic acid-co-caprolactone) sutures were treated with non-thermal atmospheric plasma to eradicate contaminating bacteria like Staphylococcus aureus and Escherichia coli. Moreover, sutures were pre-treated with non-thermal atmospheric plasma and then exposed to S. aureus and E. coli. Our results revealed that non-thermal atmospheric plasma treatment effectively eradicates contaminating bacteria on sutures, and non-thermal atmospheric plasma pre-treatment effectively prevents bacterial colonization on sutures without altering their mechanical properties. Chemical characterization of sutures was performed with FT-IR and XPS and results showed that non-thermal atmospheric plasma treatment substantially increased the hydrophilicity of sutures which might be the primary mechanism for the prevention of bacterial colonization. In conclusion, plasma-treated sutures could be considered as novel alternative materials for the control and prevention of surgical site infections.
Collapse
|
26
|
Tae BS, Park JH, Kim JK, Ku JH, Kwak C, Kim HH, Jeong CW. Comparison of intraoperative handling and wound healing between (NEOSORB® plus) and coated polyglactin 910 suture (NEOSORB®): a prospective, single-blind, randomized controlled trial. BMC Surg 2018; 18:45. [PMID: 29980202 PMCID: PMC6035400 DOI: 10.1186/s12893-018-0377-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/26/2018] [Indexed: 01/27/2023] Open
Abstract
Background Coated polyglactin 910 suture with chlorhexidine (NEOSORB® Plus) has recently been developed to imbue the parent suture with antibacterial activity against organisms that commonly cause surgical site infections (SSI). This prospective, single-blinded, randomized trial, was performed to compare the intraoperative handling and wound healing characteristics of NEOSORB® Plus with those of the traditional polyglactin 910 suture (NEOSORB®) in urologic surgery patients. Methods Patients (aged 19 to 80 years, n = 100) were randomized in a 1:1 ratio for treatment with either NEOSORB® Plus or NEOSORB®, and stratified into an open surgery or a minimally invasive surgery group. The primary endpoint was the assessment of overall intraoperative handling of the sutures. Secondary endpoints included specific intraoperative handling measures and wound healing characteristics. Wound healing was assessed at one and 11 days after surgery. Cumulative skin infection, seroma, and suture sinus events within 30 days after surgery were also evaluated. Results A total of 96 patients were included, with 47 patients in the NEOSORB® Plus group and 49 patients in the NEOSORB® group. Scores for intraoperative handling were favorable and were not significantly different between the two suture groups. Wound healing characteristics were also comparable. The incidence of adverse events was 13.6%, although none were deemed attributable to the suture, and no difference was observed between the two groups. Conclusions NEOSORB® Plus is not inferior to traditional sutures in terms of intraoperative handling and wound healing, potentially making NEOSORB® Plus a beneficial alternative for patients at increased risk of SSI. Trial registration ClinicalTrials.gov: NCT02431039. Trial registration date 14 August 2015. Electronic supplementary material The online version of this article (10.1186/s12893-018-0377-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Ansan, South Korea
| | - Ju Hyun Park
- Department of Urology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University Hospital, Seoul, South Korea
| | - Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| |
Collapse
|
27
|
Linderman SW, Shen H, Yoneda S, Jayaram R, Tanes ML, Sakiyama-Elbert SE, Xia Y, Thomopoulos S, Gelberman RH. Effect of connective tissue growth factor delivered via porous sutures on the proliferative stage of intrasynovial tendon repair. J Orthop Res 2018; 36:2052-2063. [PMID: 29266404 PMCID: PMC6013340 DOI: 10.1002/jor.23842] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/27/2017] [Indexed: 02/04/2023]
Abstract
Recent growth factor, cell, and scaffold-based experimental interventions for intrasynovial flexor tendon repair have demonstrated therapeutic potential in rodent models. However, these approaches have not achieved consistent functional improvements in large animal trials due to deleterious inflammatory reactions to delivery materials and insufficient induction of targeted biological healing responses. In this study, we achieved porous suture-based sustained delivery of connective tissue growth factor (CTGF) into flexor tendons in a clinically relevant canine model. Repairs with CTGF-laden sutures were mechanically competent and did not show any evidence of adhesions or other negative inflammatory reactions based on histology, gene expression, or proteomics analyses at 14 days following repair. CTGF-laden sutures induced local cellular infiltration and a significant biological response immediately adjacent to the suture, including histological signs of angiogenesis and collagen deposition. There were no evident widespread biological effects throughout the tendon substance. There were significant differences in gene expression of the macrophage marker CD163 and anti-apoptotic factor BCL2L1; however, these differences were not corroborated by proteomics analysis. In summary, this study provided encouraging evidence of sustained delivery of biologically active CTGF from porous sutures without signs of a negative inflammatory reaction. With the development of a safe and effective method for generating a positive local biological response, future studies can explore additional methods for enhancing intrasynovial tendon repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2052-2063, 2018.
Collapse
Affiliation(s)
- Stephen W. Linderman
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri,Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Susumu Yoneda
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Rohith Jayaram
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| | - Michael L. Tanes
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Younan Xia
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, 650 W 168 ST, Black Building 1408, New York 10025 New York
| | - Richard H. Gelberman
- Department of Orthopaedic Surgery, Washington University, 660 S. Euclid Avenue, Campus Box 8233, St. Louis 63110 Missouri
| |
Collapse
|
28
|
Dey P, Mukherjee S, Das G, Ramesh A. Micellar chemotherapeutic platform based on a bifunctional salicaldehyde amphiphile delivers a "combo-effect" for heightened killing of MRSA. J Mater Chem B 2018; 6:2116-2125. [PMID: 32254434 DOI: 10.1039/c7tb03150e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The devastating infections caused by methicillin-resistant Staphylococcus aureus (MRSA) coupled with its high resistance towards antibiotics underscores the need for an effective anti-MRSA therapeutic. The present study illustrates the use of a salicylaldehyde based bactericidal amphiphile (C1) in generating a micellar carrier that renders delivery of therapeutic antibiotics. The inherent membrane-targeting activity of C1 present in the micelle could be leveraged to counter the resistance of MRSA and enhance cellular uptake of the released antibiotics, resulting in effective elimination of the pathogen. The inherent bactericidal and antibiofilm activity of C1 was captured in FESEM analysis, solution-based assays and fluorescence microscopy. ANS-based fluorescence spectroscopy indicated that the critical micelle concentration (CMC) for C1 was 18.5 μM in water. DLS studies and FESEM analysis indicated that the average particle size for micelles based on C1 (C1M) and rifampicin-loaded C1M (C1M- R) was smaller than vancomycin-loaded C1M (C1M- V). C1M- R and C1M- V rendered sustained release of the antibiotics in physiologically relevant fluids. Notably, following interaction with MRSA for 3 h, the relative anti-MRSA activity of C1M- R and C1M- V was nearly 12-fold and 8-fold higher, respectively, as compared to the free antibiotics at equivalent concentration, highlighting the merit of leveraging the activity of C1 and the antibiotic concurrently in the micellar system. The relative cell-free antibiotic was also manifold lower in the case of C1M- R and C1M- V treated MRSA as against treatment with free antibiotics, suggesting that the amphiphilic warhead breached the membrane barrier and enhanced cellular uptake of the released antibiotics. Interestingly, C1M- R and C1M- V exhibited a high therapeutic index, being non-toxic to HEK 293 cells at concentrations higher than their minimum inhibitory concentration (MIC) against MRSA and they could be employed as an antibacterial coating to prevent MRSA biofilm formation on surgical silk sutures. The antibiotic-replete biocompatible micelles based on a self-assembling membrane-targeting amphiphile described herein represent a promising framework to integrate multiple warheads and generate a potent anti-MRSA therapeutic material.
Collapse
Affiliation(s)
- Poulomi Dey
- Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India.
| | | | | | | |
Collapse
|
29
|
Liu H, Wang C, Li C, Qin Y, Wang Z, Yang F, Li Z, Wang J. A functional chitosan-based hydrogel as a wound dressing and drug delivery system in the treatment of wound healing. RSC Adv 2018; 8:7533-7549. [PMID: 35539132 PMCID: PMC9078458 DOI: 10.1039/c7ra13510f] [Citation(s) in RCA: 433] [Impact Index Per Article: 72.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/12/2018] [Indexed: 12/18/2022] Open
Abstract
Functional active wound dressings are expected to provide a moist wound environment, offer protection from secondary infections, remove wound exudate and accelerate tissue regeneration, as well as to improve the efficiency of wound healing. Chitosan-based hydrogels are considered as ideal materials for enhancing wound healing owing to their biodegradable, biocompatible, non-toxic, antimicrobial, biologically adhesive, biological activity and hemostatic effects. Chitosan-based hydrogels have been demonstrated to promote wound healing at different wound healing stages, and also can alleviate the factors against wound healing (such as excessive inflammatory and chronic wound infection). The unique biological properties of a chitosan-based hydrogel enable it to serve as both a wound dressing and as a drug delivery system (DDS) to deliver antibacterial agents, growth factors, stem cells and so on, which could further accelerate wound healing. For various kinds of wounds, chitosan-based hydrogels are able to promote the effectiveness of wound healing by modifying or combining with other polymers, and carrying different types of active substances. In this review, we will take a close look at the application of chitosan-based hydrogels in wound dressings and DDS to enhance wound healing.
Collapse
Affiliation(s)
- He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Chenyu Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
- Hallym University 1Hallymdaehak-gil Chuncheon Gangwon-do 200-702 Korea
| | - Chen Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Yanguo Qin
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Fan Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Zuhao Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| | - Jincheng Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University Changchun 130041 P. R. China
| |
Collapse
|
30
|
Obermeier A, Schneider J, Harrasser N, Tübel J, Mühlhofer H, Pförringer D, von Deimling C, Foehr P, Kiefel B, Krämer C, Stemberger A, Schieker M, Burgkart R, von Eisenhart-Rothe R. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PLoS One 2018; 13:e0190912. [PMID: 29315313 PMCID: PMC5760023 DOI: 10.1371/journal.pone.0190912] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/22/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. OBJECTIVES This 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. METHODS As 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. RESULTS Zone 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). CONCLUSIONS Novel 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 for a fast bacterial eradication. This suture coating shows the lowest survival rate of adhering as well as planktonic bacteria, a high drug release during the first-clinically most relevant- 48 hours, as well as biocompatibility. Thus, CL11 coatings should be recommended for prophylactic antimicrobial sutures as an optimal surgical supplement to reduce wound infections. However, animal and clinical investigations are important to prove safety and efficacy for future applications.
Collapse
Affiliation(s)
- Andreas Obermeier
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
- * E-mail:
| | - Jochen Schneider
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Norbert Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Jutta Tübel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Heinrich Mühlhofer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Dominik Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Constantin von Deimling
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Peter Foehr
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Barbara Kiefel
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Christina Krämer
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Axel Stemberger
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Matthias Schieker
- Klinik für Chirurgie, Experimentelle Chirurgie und Regenerative Medizin, Klinikum der Universität München, München, Germany
| | - Rainer Burgkart
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Rüdiger von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| |
Collapse
|
31
|
Gu Z, Yin H, Wang J, Ma L, Morsi Y, Mo X. Fabrication and characterization of TGF-β1-loaded electrospun poly (lactic-co-glycolic acid) core-sheath sutures. Colloids Surf B Biointerfaces 2018; 161:331-338. [DOI: 10.1016/j.colsurfb.2017.10.066] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/25/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023]
|
32
|
Surgical suture braided with a diclofenac-loaded strand of poly(lactic-co-glycolic acid) for local, sustained pain mitigation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017. [DOI: 10.1016/j.msec.2017.05.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
33
|
Chen S, Ge L, Gombart AF, Shuler FD, Carlson MA, Reilly DA, Xie J. Nanofiber-based sutures induce endogenous antimicrobial peptide. Nanomedicine (Lond) 2017; 12:2597-2609. [PMID: 28960168 DOI: 10.2217/nnm-2017-0161] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM The aim of this study was to develop nanofiber-based sutures capable of inducing endogenous antimicrobial peptide production. METHODS We used co-axial electrospinning deposition and rolling to fabricate sutures containing pam3CSK4 peptide and 25-hydroxyvitamin D3 (25D3). RESULTS The diameters and mechanical properties of the sutures were adjustable to meet the criteria of United States Pharmacopeia designation. 25D3 exhibited a sustained release from nanofiber sutures over 4 weeks. Pam3CSK4 peptide also showed an initial burst followed by a sustained release over 4 weeks. The co-delivery of 25D3 and pam3CSK4 peptide enhanced cathelicidin antimicrobial peptide production from U937 cells and keratinocytes compared with 25D3 delivery alone. In addition, the 25D3/pam3CSK4 peptide co-loaded nanofiber sutures did not significantly influence proliferation of keratinocytes, fibroblasts, or the monocytic cell lines U937 and HL-60. CONCLUSION The use of 25D3/pam3CSK4 peptide co-loaded nanofiber sutures could potentially induce endogenous antimicrobial peptide production and reduce surgical site infections.
Collapse
Affiliation(s)
- Shixuan Chen
- Department of Surgery-Transplant & Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Liangpeng Ge
- Chongqing Academy of Animal Sciences & Key Laboratory of Pig Industry Sciences, Ministry of Agriculture, Chongqing, China
| | - Adrian F Gombart
- Department of Biochemistry & Biophysics & Linus Pauling Institute, Oregon State University, Corvallis, OR 97331, USA
| | - Franklin D Shuler
- Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25755, USA
| | - Mark A Carlson
- Department of Surgery-General Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Debra A Reilly
- Department of Surgery-Plastic Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Jingwei Xie
- Department of Surgery-Transplant & Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
34
|
Lee EJ, Huh BK, Kim SN, Lee JY, Park CG, Mikos AG, Choy YB. Application of Materials as Medical Devices with Localized Drug Delivery Capabilities for Enhanced Wound Repair. PROGRESS IN MATERIALS SCIENCE 2017; 89:392-410. [PMID: 29129946 PMCID: PMC5679315 DOI: 10.1016/j.pmatsci.2017.06.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The plentiful assortment of natural and synthetic materials can be leveraged to accommodate diverse wound types, as well as different stages of the healing process. An ideal material is envisioned to promote tissue repair with minimal inconvenience for patients. Traditional materials employed in the clinical setting often invoke secondary complications, such as infection, pain, foreign body reaction, and chronic inflammation. This review surveys the repertoire of surgical sutures, wound dressings, surgical glues, orthopedic fixation devices and bone fillers with drug eluting capabilities. It highlights the various techniques developed to effectively incorporate drugs into the selected material or blend of materials for both soft and hard tissue repair. The mechanical and chemical attributes of the resultant materials are also discussed, along with their biological outcomes in vitro and/or in vivo. Perspectives and challenges regarding future research endeavors are also delineated for next-generation wound repair materials.
Collapse
Affiliation(s)
- Esther J. Lee
- Department of Bioengineering, Rice University, MS 142, P.O. Box 1892, Houston, Texas, 77251-1892, USA
| | - Beom Kang Huh
- Interdisciplinary Program for Bioengineering, Seoul National University College of Engineering, Seoul, Republic of Korea
| | - Se Na Kim
- Interdisciplinary Program for Bioengineering, Seoul National University College of Engineering, Seoul, Republic of Korea
| | - Jae Yeon Lee
- Interdisciplinary Program for Bioengineering, Seoul National University College of Engineering, Seoul, Republic of Korea
| | - Chun Gwon Park
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Antonios G. Mikos
- Department of Bioengineering, Rice University, MS 142, P.O. Box 1892, Houston, Texas, 77251-1892, USA
- Department of Chemical and Biomolecular Engineering, Rice University, MS 362, P.O. Box 1892, Houston, Texas, 77251-1892, USA
| | - Young Bin Choy
- Interdisciplinary Program for Bioengineering, Seoul National University College of Engineering, Seoul, Republic of Korea
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Republic of Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
35
|
Márquez Y, Cabral T, Lorenzetti A, Franco L, Turon P, del Valle LJ, Puiggalí J. Incorporation of chloramphenicol and captopril into poly(GL)- b-poly(GL- co-TMC- co-CL)- b-poly(GL) monofilar surgical sutures. J Appl Polym Sci 2017. [DOI: 10.1002/app.44762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yolanda Márquez
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
- B. Braun Surgical S.A, Carretera de Terrassa 121; Rubí (Barcelona) 08191 Spain
| | - Tània Cabral
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
| | - Alice Lorenzetti
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
| | - Lourdes Franco
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
| | - Pau Turon
- B. Braun Surgical S.A, Carretera de Terrassa 121; Rubí (Barcelona) 08191 Spain
| | - Luís J. del Valle
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
| | - Jordi Puiggalí
- Chemical Engineering Department; Escola d'Enginyeria de Barcelona Est-EEBE, c/Eduard Maristany 10-14; Barcelona E-08019 Spain
| |
Collapse
|
36
|
Márquez Y, Cabral T, Lorenzetti A, Franco L, Turon P, Del Valle LJ, Puiggalí J. Incorporation of biguanide compounds into poly(GL)-b-poly(GL-co-TMC-co-CL)-b-poly(GL) monofilament surgical sutures. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 71:629-640. [PMID: 27987754 DOI: 10.1016/j.msec.2016.10.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/13/2016] [Accepted: 10/23/2016] [Indexed: 10/20/2022]
Abstract
A new biodegradable coating was developed for bioabsorbable monofilament sutures. Specifically, a random copolymer having 35wt-% and 65wt-% of lactide and trimethylene carbonate units showed appropriate flexibility, stickiness and degradation rate, as well as capability to produce a complete and uniform coating. Monofilament sutures of polyglycolide-b-poly(glycolide-co-trimethylene carbonate-co-ε-caprolactone)-b-polyglycolide were loaded with chlorhexidine (CHX) and poly(hexamethylene biguanide) (PHMB) to explore the possibility to achieve antimicrobial activity without adverse cytotoxic effects. To this end, two processes based on single drug adsorption onto the suture surface and incorporation into the coating copolymer were used and subsequently evaluated. Although the second process could be considered more complex, clear benefits were observed in terms of drug loading efficiency, antimicrobial effect and even lack of cytotoxicity. In general, drugs could be loaded in an amount leading to a clear bacteriostatic effect for both Gram-negative and Gram-positive bacteria without causing significant cytotoxicity. Release profiles of PHMB and CHX were clearly different. Specifically, adsorption of the drug onto the fiber surface which prevented complete release was detected for PHMB. This polymer had advantages derived from its high molecular size, which hindered penetration into cells, thus resulting in lower cytotoxicity. Furthermore, bacterial growth kinetics measurements and bacterial adhesion assays showed greater effectiveness of this polymer.
Collapse
Affiliation(s)
- Yolanda Márquez
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain; B. Braun Surgical S.A., Carretera de Terrasa 121, Rubí, Barcelona, 08191, Spain
| | - Tània Cabral
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain
| | - Alice Lorenzetti
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain
| | - Lourdes Franco
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain
| | - Pau Turon
- B. Braun Surgical S.A., Carretera de Terrasa 121, Rubí, Barcelona, 08191, Spain
| | - Luís J Del Valle
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain
| | - Jordi Puiggalí
- Departament d'Enginyeria Química, Universitat Politècnica de Catalunya, Av. Diagonal 647, Barcelona E-08028, Spain.
| |
Collapse
|
37
|
Kashiwabuchi F, Parikh KS, Omiadze R, Zhang S, Luo L, Patel HV, Xu Q, Ensign LM, Mao HQ, Hanes J, McDonnell PJ. Development of Absorbable, Antibiotic-Eluting Sutures for Ophthalmic Surgery. Transl Vis Sci Technol 2017; 6:1. [PMID: 28083445 PMCID: PMC5225995 DOI: 10.1167/tvst.6.1.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 10/23/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To develop and evaluate an antibiotic-eluting suture for ophthalmic surgery. Methods Wet electrospinning was used to manufacture sutures composed of poly(L-lactide), polyethylene glycol (PEG), and levofloxacin. Size, morphology, and mechanical strength were evaluated via scanning electron microscopy and tensile strength, respectively. In vitro drug release was quantified using high performance liquid chromatography. In vitro suture activity against Staphylococcus epidermidis was investigated through bacterial inhibition studies. Biocompatibility was determined via histological analysis of tissue sections surrounding sutures implanted into Sprague-Dawley rat corneas. Results Sutures manufactured via wet electrospinning were 45.1 ± 7.7 μm in diameter and 0.099 ± 0.007 newtons (N) in breaking strength. The antibiotic release profile demonstrated a burst followed by sustained release for greater than 60 days. Increasing PEG in the polymer formulation, from 1% to 4% by weight, improved drug release without negatively affecting tensile strength. Sutures maintained a bacterial zone of inhibition for at least 1 week in vitro and elicited an in vivo tissue reaction comparable to a nylon suture. Conclusions There is a need for local, postoperative delivery of antibiotics following ophthalmic procedures. Wet electrospinning provides a suitable platform for the development of sutures that meet size requirements for ophthalmic surgery and are capable of sustained drug release; however, tensile strength must be improved prior to clinical use. Translational Relevance No antibiotic-eluting suture exists for ophthalmic surgery. A biocompatible, high strength suture capable of sustained antibiotic release could prevent ocular infection and preclude compliance issues with topical eye drops.
Collapse
Affiliation(s)
- Fabiana Kashiwabuchi
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kunal S Parikh
- Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Revaz Omiadze
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shuming Zhang
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA ; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA ; Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD, USA
| | - Lixia Luo
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Himatkumar V Patel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Qingguo Xu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Laura M Ensign
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Hai-Quan Mao
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD 21218, USA ; Institute for NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA ; Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, MD, USA
| | - Justin Hanes
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Center for Nanomedicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA ; Departments of Environmental Health Sciences, Oncology, Neurosurgery, and Pharmacology & Molecular Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J McDonnell
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
38
|
Abstract
Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.
Collapse
Affiliation(s)
- Jaiben George
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
39
|
Kim H, Kim BH, Huh BK, Yoo YC, Heo CY, Choy YB, Park JH. Surgical suture releasing macrophage-targeted drug-loaded nanoparticles for an enhanced anti-inflammatory effect. Biomater Sci 2017; 5:1670-1677. [DOI: 10.1039/c7bm00345e] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
An anti-inflammatory nanoparticle-coated suture reduces inflammation and pain at the wound site.
Collapse
Affiliation(s)
- Hansol Kim
- Department of Bio and Brain Engineering and KAIST Institute of Health Science and Technology
- Korea Advanced Institute of Science and Technology
- Daejeon
- Republic of Korea
| | - Byung Hwi Kim
- Department of Biomedical Engineering
- College of Medicine
- Seoul National University
- Seoul
- Republic of Korea
| | - Beom Kang Huh
- Interdisciplinary Program in Bioengineering
- College of Engineering
- Seoul National University
- Seoul
- Republic of Korea
| | - Yeon Chun Yoo
- Research center
- Metabiomed Co. Ltd
- Cheongju
- Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery
- College of Medicine
- Seoul National University
- Seoul
- Republic of Korea
| | - Young Bin Choy
- Department of Biomedical Engineering
- College of Medicine
- Seoul National University
- Seoul
- Republic of Korea
| | - Ji-Ho Park
- Department of Bio and Brain Engineering and KAIST Institute of Health Science and Technology
- Korea Advanced Institute of Science and Technology
- Daejeon
- Republic of Korea
| |
Collapse
|
40
|
Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. THE LANCET. INFECTIOUS DISEASES 2016; 16:e288-e303. [PMID: 27816414 DOI: 10.1016/s1473-3099(16)30402-9] [Citation(s) in RCA: 471] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.
Collapse
Affiliation(s)
- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland.
| | - Bassim Zayed
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - N Zeynep Kubilay
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Stijn de Jonge
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Fleur de Vries
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Sarah Gans
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Elon D Wallert
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Xiuwen Wu
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mohamed Abbas
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | | | - Jianan Ren
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Joseph S Solomkin
- OASIS Global, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | |
Collapse
|
41
|
Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis 2016; 36:19-32. [DOI: 10.1007/s10096-016-2765-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/22/2016] [Indexed: 01/27/2023]
|
42
|
Antimicrobial Formulations of Absorbable Bone Substitute Materials as Drug Carriers Based on Calcium Sulfate. Antimicrob Agents Chemother 2016; 60:3897-905. [PMID: 27067337 DOI: 10.1128/aac.00080-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/01/2016] [Indexed: 11/20/2022] Open
Abstract
Substitution of bones is a well-established, necessary procedure to treat bone defects in trauma and orthopedic surgeries. For prevention or treatment of perioperative infection, the implantation of resorbable bone substitute materials carrying antibiotics is a necessary treatment. In this study, we investigated the newly formulated calcium-based resorbable bone substitute materials containing either gentamicin (CaSO4-G [Herafill-G]), vancomycin (CaSO4-V), or tobramycin (Osteoset). We characterized the released antibiotic concentration per unit. Bone substitute materials were implanted in bones of rabbits via a standardized surgical procedure. Clinical parameters and levels of the antibiotic-releasing materials in serum were determined. Local concentrations of antibiotics were measured using antimicrobial tests of bone tissue. Aminoglycoside release kinetics in vitro per square millimeter of bead surface showed the most prolonged release for gentamicin, followed by vancomycin and, with the fastest release, tobramycin. In vivo level in serum detected over 28 days was highest for gentamicin at 0.42 μg/ml, followed by vancomycin at 0.11 μg/ml and tobramycin at 0.04 μg/ml. The clinical parameters indicated high biocompatibility for materials used. None of the rabbits subjected to the procedure showed any adverse reaction. The highest availability of antibiotics at 14.8 μg/g on day 1 in the cortical tibia ex vivo was demonstrated for gentamicin, decreasing within 14 days. In the medulla, vancomycin showed a high level at 444 μg/g on day 1, decreasing continuously over 14 days, whereas gentamicin decreased faster within the initial 3 days. The compared antibiotic formulations varied significantly in release kinetics in serum as well as locally in medulla and cortex.
Collapse
|
43
|
Li J, Linderman SW, Zhu C, Liu H, Thomopoulos S, Xia Y. Surgical Sutures with Porous Sheaths for the Sustained Release of Growth Factors. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2016; 28:4620-4. [PMID: 27059654 PMCID: PMC4938160 DOI: 10.1002/adma.201506242] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/22/2016] [Indexed: 05/23/2023]
Abstract
Surgical sutures with highly porous sheaths are developed using a swelling and freeze-drying procedure without compromising their mechanical properties. The modified sutures show a high capacity for loading biofactors and are able to release the loaded biofactors in a sustained manner.
Collapse
Affiliation(s)
- Jianhua Li
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- State Key Laboratory of Crystal Materials, Shandong University, Jinan, Shandong, 250100, P. R. China
| | - Stephen W Linderman
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, 63130, USA
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Chunlei Zhu
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Hong Liu
- State Key Laboratory of Crystal Materials, Shandong University, Jinan, Shandong, 250100, P. R. China
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, 10032, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, 10027, USA
| | - Younan Xia
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, 30332, USA
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| |
Collapse
|
44
|
Dennis C, Sethu S, Nayak S, Mohan L, Morsi YY, Manivasagam G. Suture materials - Current and emerging trends. J Biomed Mater Res A 2016; 104:1544-59. [DOI: 10.1002/jbm.a.35683] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/07/2016] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Christopher Dennis
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation; Bangalore Karnataka 560099 India
| | - Sunita Nayak
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
- School of Bio Sciences and Technology, VIT University; Vellore Tamil Nadu 632014 India
| | - Loganathan Mohan
- Surface Engineering Division; CSIR - National Aerospace Laboratories; Bangalore Karnataka 560017 India
| | - Yosry Yos Morsi
- Biomechanical and Tissue Engineering Labs, Faculty of Science, Engineering and Technology, Swinburne University of Technology; Australia
| | - Geetha Manivasagam
- Centre for Biomaterials Science and Technology, School of Mechanical and Building Sciences, VIT University; Vellore Tamil Nadu 632014 India
| |
Collapse
|
45
|
Padmakumar S, Joseph J, Neppalli MH, Mathew SE, Nair SV, Shankarappa SA, Menon D. Electrospun Polymeric Core-sheath Yarns as Drug Eluting Surgical Sutures. ACS APPLIED MATERIALS & INTERFACES 2016; 8:6925-34. [PMID: 26936629 DOI: 10.1021/acsami.6b00874] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Drug-coated sutures are widely used as delivery depots for antibiotics and anti-inflammatory drugs at surgical wound sites. Although drug-laden coating provides good localized drug concentration, variable loading efficiency and release kinetics limits its use. Alternatively, drug incorporation within suture matrices is hampered by the harsh fabrication conditions required for suture-strength enhancement. To circumvent these limitations, we fabricated mechanically robust electrospun core-sheath yarns as sutures, with a central poly-l-lactic acid core, and a drug-eluting poly-lactic-co-glycolic acid sheath. The electrospun sheath was incorporated with aceclofenac or insulin to demonstrate versatility of the suture in loading both chemical and biological class of drugs. Aceclofenac and insulin incorporated sutures exhibited 15% and 4% loading, and release for 10 and 7 days, respectively. Aceclofenac sutures demonstrated reduced epidermal hyperplasia and cellularity in skin-inflammation animal model, while insulin loaded sutures showed enhanced cellular migration in wound healing assay. In conclusion, we demonstrate an innovative strategy of producing mechanically strong, prolonged drug-release sutures loaded with different classes of drugs.
Collapse
Affiliation(s)
- Smrithi Padmakumar
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - John Joseph
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - Madhuri Harsha Neppalli
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - Sumi Elizabeth Mathew
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - Shantikumar V Nair
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - Sahadev A Shankarappa
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| | - Deepthy Menon
- Amrita Centre for Nanosciences & Molecular Medicine, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham , Kochi 682041, Kerala, India
| |
Collapse
|
46
|
Wu DQ, Cui HC, Zhu J, Qin XH, Xie T. Novel amino acid based nanogel conjugated suture for antibacterial application. J Mater Chem B 2016; 4:2606-2613. [DOI: 10.1039/c6tb00186f] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study, a promising preparation strategy for antibacterial silk sutures with an l-lysine based nanogel grafting is reported.
Collapse
Affiliation(s)
- De-Qun Wu
- Key Laboratory of Textile Science & Technology
- Ministry Education
- College of Textiles
- Donghua University
- Songjiang
| | - Hai-Chun Cui
- Key Laboratory of Textile Science & Technology
- Ministry Education
- College of Textiles
- Donghua University
- Songjiang
| | - Jie Zhu
- Key Laboratory of Textile Science & Technology
- Ministry Education
- College of Textiles
- Donghua University
- Songjiang
| | - Xiao-Hong Qin
- Key Laboratory of Textile Science & Technology
- Ministry Education
- College of Textiles
- Donghua University
- Songjiang
| | - Ting Xie
- Department of Cardiac Surgery
- Hainan Provincial People's Hospital
- Hainan
- China
| |
Collapse
|
47
|
Chen X, Hou D, Wang L, Zhang Q, Zou J, Sun G. Antibacterial Surgical Silk Sutures Using a High-Performance Slow-Release Carrier Coating System. ACS APPLIED MATERIALS & INTERFACES 2015; 7:22394-403. [PMID: 26378964 DOI: 10.1021/acsami.5b06239] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sutures are a vital part for surgical operation, and suture-associated surgical site infections are an important issue of postoperative care. Antibacterial sutures have been proved to reduce challenging complications caused by bacterial infections. In recent decades, triclosan-free sutures have been on their way to commercialization. Alternative antibacterial substances are becoming relevant to processing surgical suture materials. Most of the antibacterial substances are loaded directly on sutures by dipping or coating methods. The aim of this study was to optimize novel antibacterial braided silk sutures based on levofloxacin hydrochloride and poly(ε-caprolactone) by two different processing sequences, to achieve suture materials with slow-release antibacterial efficacy and ideal physical and handling properties. Silk strands were processed into sutures on a circular braiding machine, and antibacterial treatment was introduced alternatively before or after braiding by two-dipping-two-rolling method (M1 group and M2 group). The antibacterial activity and durability against Staphylococcus aureus and Escherichia coli were tested. Drug release profiles were measured in phosphate buffer with different pH values, and release kinetics model was built to analyze the sustained drug release mechanism between the interface of biomaterials and the in vitro aqueous environment. Knot-pull tensile strength, thread-to-thread friction, and bending stiffness were determined to evaluate physical and handling properties of sutures. All coated sutures showed continuous antibacterial efficacy and slow drug release features for more than 5 days. Besides, treated sutures fulfilled U.S. Pharmacopoeia required knot-pull tensile strength. The thread-to-thread friction and bending stiffness for the M1 group changed slightly when compared with those of uncoated ones. However, physical and handling characteristics of the M2 group tend to approach those of monofilament ones. The novel suture showed acceptable in vitro cytotoxicity according to ISO 10993-5. Generally speaking, all coated sutures show potential in acting as antibacterial suture materials, and M1 group is proved to have a higher prospect for clinical applications.
Collapse
Affiliation(s)
- Xiaojie Chen
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
| | - Dandan Hou
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
| | - Qian Zhang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
| | - Jiahan Zou
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
| | - Gang Sun
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University , Songjiang District, Shanghai 201620, China
- Division of Textiles and Clothing, University of California , Davis, California 95616, United States
| |
Collapse
|
48
|
Obermeier A, Schneider J, Föhr P, Wehner S, Kühn KD, Stemberger A, Schieker M, Burgkart R. In vitro evaluation of novel antimicrobial coatings for surgical sutures using octenidine. BMC Microbiol 2015; 15:186. [PMID: 26404034 PMCID: PMC4583139 DOI: 10.1186/s12866-015-0523-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sutures colonized by bacteria represent a challenge in surgery due to their potential to cause surgical site infections. In order to reduce these type of infections antimicrobially coated surgical sutures are currently under development. In this study, we investigated the antimicrobial drug octenidine as a coating agent for surgical sutures. To achieve high antimicrobial efficacy and required biocompatibility for medical devices, we focused on optimizing octenidine coatings based on fatty acids. For this purpose, antimicrobial sutures were prepared with either octenidine-laurate or octenidine-palmitate at 11, 22, and 33 μg/cm drug concentration normalized per length of sutures. Octenidine containing sutures were compared to the commercial triclosan-coated suture Vicryl® Plus. The release of octenidine into aqueous solution was analyzed and long-term antimicrobial efficacy was assessed via agar diffusion tests using Staphylococcus aureus. For determining biocompatibility, cytotoxicity assays (WST-1) were performed using L-929 mouse fibroblasts. RESULTS In a 7 days elution experiment, octenidine-palmitate coated sutures demonstrated much slower drug release (11 μg/cm: 7%; 22 μg/cm: 5%; 33 μg/cm: 33%) than octenidine-laurate sutures (11 μg/cm: 82%; 22 μg/cm: 88%; 33 μg/cm: 87%). Furthermore sutures at 11 μg/cm drug content were associated with acceptable cytotoxicity according to ISO 10993-5 standard and showed, similar to Vicryl® Plus, relevant efficacy to inhibit surrounding bacterial growth for up to 9 days. CONCLUSIONS Octenidine coated sutures with a concentration of 11 μg/cm revealed high antimicrobial efficacy and biocompatibility. Due to their delayed release, palmitate carriers should be preferred. Such coatings are candidates for clinical testing in regard to their safety and efficacy.
Collapse
Affiliation(s)
- A Obermeier
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675, Munich, Germany.
| | - J Schneider
- Klinikum rechts der Isar, Technische Universität München, Institut für Mikrobiologie, Immunologie und Hygiene, Trogerstr. 30, 81675, Munich, Germany.
| | - P Föhr
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675, Munich, Germany.
| | - S Wehner
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675, Munich, Germany.
| | - K-D Kühn
- Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - A Stemberger
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675, Munich, Germany.
| | - M Schieker
- Klinikum der Universität München, Klinik für Chirurgie, Experimentelle Chirurgie und Regenerative Medizin, Nußbaumstr. 20, 80336, Munich, Germany.
| | - R Burgkart
- Klinikum rechts der Isar, Technische Universität München, Klinik für Orthopädie und Sportorthopädie, Ismaninger Str. 22, 81675, Munich, Germany.
| |
Collapse
|
49
|
Choudhury AJ, Gogoi D, Chutia J, Kandimalla R, Kalita S, Kotoky J, Chaudhari YB, Khan MR, Kalita K. Controlled antibiotic-releasing Antheraea assama silk fibroin suture for infection prevention and fast wound healing. Surgery 2015; 159:539-47. [PMID: 26328475 DOI: 10.1016/j.surg.2015.07.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/22/2015] [Accepted: 07/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The quest for developing silk fibroin as a biomaterial for drug release systems continues to draw research interest owing to its impressive mechanical properties as well as biocompatibility and biodegradability. The aim of this study is to develop low-temperature O2 plasma-treated muga (Antheraea assama) silk fibroin (AASF) yarn impregnated with amoxicillin trihydrate as controlled antibiotic-releasing suture (AASF/O2/AMOX) for preventing postoperative site bacterial infection and fast wound healing. METHODS In this experimental study, AASF and AASF/O2/AMOX sutures are used to close the surgical wounds of adult male Wistar rats of 4 months old and weighing 200-230 g. RESULTS Surface hydrophilicity induced by O2 plasma results in an increase in drug-impregnation efficiency of AASF/O2 yarn by 16.7%. In vitro drug release profiles show continuous and prolonged release of AMOX from AASF/O2/AMOX yarn up to 336 hours. In vitro hemolysis assay reveals that O2 plasma treatment and subsequent impregnation of AMOX do not affect the heertetmocompatibility of AASF yarn. The AASF/O2/AMOX yarn proves to be effective for in vitro growth inhibition of Staphylococcus aureus and Escherichia coli, whereas AASF offers no antibacterial activity against both types of bacteria. In vivo histopathology studies and colony-forming unit count data revealed accelerated wound healing activity of AASF/O2/AMOX over AASF yarn through rapid synthesis and proliferation of collagen, hair follicle, and connective tissues. CONCLUSION Outcomes of this work clearly demonstrate the potential use of AASF/O2/AMOX yarn as a controlled antibiotic-releasing suture biomaterial for superficial surgical applications.
Collapse
Affiliation(s)
| | - Dolly Gogoi
- Physical Sciences Division, Institute of Advanced Study in Science and Technology, Assam, India
| | - Joyanti Chutia
- Physical Sciences Division, Institute of Advanced Study in Science and Technology, Assam, India
| | - Raghuram Kandimalla
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology, Assam, India
| | - Sanjeeb Kalita
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology, Assam, India
| | - Jibon Kotoky
- Drug Discovery Laboratory, Institute of Advanced Study in Science and Technology, Assam, India
| | - Yogesh B Chaudhari
- Molecular Biology and Microbial Biotechnology Laboratory, Institute of Advanced Study in Science and Technology, Assam, India
| | - Mojibur R Khan
- Molecular Biology and Microbial Biotechnology Laboratory, Institute of Advanced Study in Science and Technology, Assam, India
| | | |
Collapse
|
50
|
Boateng J, Catanzano O. Advanced Therapeutic Dressings for Effective Wound Healing--A Review. J Pharm Sci 2015; 104:3653-3680. [PMID: 26308473 DOI: 10.1002/jps.24610] [Citation(s) in RCA: 471] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/15/2022]
Abstract
Advanced therapeutic dressings that take active part in wound healing to achieve rapid and complete healing of chronic wounds is of current research interest. There is a desire for novel strategies to achieve expeditious wound healing because of the enormous financial burden worldwide. This paper reviews the current state of wound healing and wound management products, with emphasis on the demand for more advanced forms of wound therapy and some of the current challenges and driving forces behind this demand. The paper reviews information mainly from peer-reviewed literature and other publicly available sources such as the US FDA. A major focus is the treatment of chronic wounds including amputations, diabetic and leg ulcers, pressure sores, and surgical and traumatic wounds (e.g., accidents and burns) where patient immunity is low and the risk of infections and complications are high. The main dressings include medicated moist dressings, tissue-engineered substitutes, biomaterials-based biological dressings, biological and naturally derived dressings, medicated sutures, and various combinations of the above classes. Finally, the review briefly discusses possible prospects of advanced wound healing including some of the emerging physical approaches such as hyperbaric oxygen, negative pressure wound therapy and laser wound healing, in routine clinical care.
Collapse
Affiliation(s)
- Joshua Boateng
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK.
| | - Ovidio Catanzano
- Department of Pharmaceutical, Chemical and Environmental Sciences, Faculty of Engineering and Science, University of Greenwich, Chatham Maritime, Kent ME4 4TB, UK
| |
Collapse
|