title: Novel high efficient coatings for anti-microbial surgical sutures using chlorhexidine in fatty acid slow-release carrier systems.
abstract: Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the "gold standard" in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures.
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermeier
authors.affiliation: Institut für Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Wehner
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Florian Dominik
authors.initials: FD
authors.lastname: Matl
authors.affiliation: Experimentelle Chirurgie und Regenerative Medizin, Klinik für Chirurgie, Klinikum der Universität München, München, Bavaria, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schieker
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Eisenhart-Rothe
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Stemberger
authors.affiliation: Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Burgkart
mesh_terms: D000891:Anti-Infective Agents, Local / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D002710:Chlorhexidine / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D020099:Coated Materials, Biocompatible / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D003692:Delayed-Action Preparations / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D004791:Enzyme Inhibitors / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D006801:Humans; D019308:Palmitic Acid / Q000737:chemistry / Q000493:pharmacokinetics / Q000494:pharmacology; D013211:Staphylococcus aureus / Q000254:growth & development*; D013537:Sutures
chemical_list: D000891:Anti-Infective Agents, Local; D020099:Coated Materials, Biocompatible; D003692:Delayed-Action Preparations; D004791:Enzyme Inhibitors; D019308:Palmitic Acid; D002710:Chlorhexidine