title: Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination?
abstract: BACKGROUND
  Surgical site infections are associated with severe morbidity and mortality. The role of surgical sutures in the etiology of surgical site infection has been the objective of discussion for decades. This study used a standardized in vitro microbiologic model to assess bacterial adherence and the antibacterial activity of a triclosan-coated polyglactin 910 (braided) suture against selected Gram-positive and Gram-negative clinical isolates that may infect surgical wounds.
  
  
  METHODS
  Standardized cultures (2.0 log(10) colony forming units/mL and 5.0 log(10) colony forming units/mL of three clinical strains, Staphyllococcus aureus (methicillin-resistant S aureus [MRSA]), S epidermidis (biofilm-positive) and Escherichia coli (extended-spectrum beta-lactamase [ESBL]-producer) were inoculated to triclosan-coated and noncoated polyglactin 910 sutures to evaluate comparative adherence of bacterial isolates to the antibacterial coated and noncoated surgical sutures; to assess the impact of serum proteins (bovine serum albumin) on antibacterial activity of triclosan-coated suture; and to document the duration of antibacterial activity of the triclosan-coated material. Selected suture samples were prepared for scanning electron microscopy to demonstrate bacterial adherence.
  
  
  RESULTS
  Substantial (p < 0.01) reductions in both Gram-positive and Gram-negative bacterial adherence were observed on triclosan-coated sutures compared with noncoated material. Pretreatment of surgical sutures with 20% BSA did not diminish antibacterial activity of the triclosan-coated braided device compared with noncoated suture (p < 0.01), and antibacterial activity was documented to persist for at least 96 hours compared with controls (p < 0.01).
  
  
  CONCLUSIONS
  The in vitro model demonstrated a considerable reduction (p < 0.01) in Gram-positive and Gram-negative bacterial adherence to a triclosan-coated braided suture, which was associated with decreased microbial viability (p < 0.001). Because bacterial contamination of suture material within a surgical wound may increase the virulence of a surgical site infection, treating the suture with triclosan provides an effective strategy for reducing perioperative surgical morbidity.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Edmiston
authors.forename: Gary R
authors.initials: GR
authors.lastname: Seabrook
authors.forename: Michael P
authors.initials: MP
authors.lastname: Goheen
authors.forename: Candace J
authors.initials: CJ
authors.lastname: Krepel
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Johnson
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lewis
authors.forename: Kellie R
authors.initials: KR
authors.lastname: Brown
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Towne
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001422:Bacterial Adhesion / Q000187:drug effects*; D020099:Coated Materials, Biocompatible; D004926:Escherichia coli / Q000187:drug effects / Q000254:growth & development; D066298:In Vitro Techniques; D011098:Polyglactin 910; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development; D013537:Sutures; D014260:Triclosan / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D020099:Coated Materials, Biocompatible; D011098:Polyglactin 910; D014260:Triclosan