Obermeier Andreas, Schneider Jochen, Wehner Steffen, Matl Florian Dominik, Schieker Matthias, von Eisenhart-Rothe Rüdiger, Stemberger Axel, Burgkart Rainer
Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
Institut für Mikrobiologie, Immunologie und Hygiene, Klinikum rechts der Isar, Technische Universität München, München, Bavaria, Germany.
PLoS One. 2014 Jul 1;9(7):e101426. doi: 10.1371/journal.pone.0101426. eCollection 2014.
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.
由于毛细作用导致细菌渗透伤口，缝线可能会引发具有挑战性的手术部位感染。抗菌缝线可通过抑制病原菌来避免这些并发症。最近，首次报道了对三氯生的耐药性，因此替代物质在临床上变得越来越重要。作为三氯生的替代品，使用了口腔抗菌剂中的“金标准”氯己定。本研究的目的是优化基于脂肪酸的新型缓释氯己定涂层手术缝线，以达到高抗菌效果并同时具有高生物相容性。用月桂酸氯己定和棕榈酸氯己定溶液对缝线进行涂层，使每长度的药物浓度达到11、22或33μg/cm。在水性洗脱液中测定药物释放曲线。在琼脂扩散试验中评估对金黄色葡萄球菌的抗菌效果。通过既定的细胞毒性试验（WST-1）评估生物相容性。一种市售含三氯生的缝线（Vicryl Plus）用作抗菌对照。所有涂层缝线均符合欧洲药典要求的拉伸强度，并证明在96小时内持续缓慢释放药物，且涂层药物未完全洗脱。观察到长达5天的高抗菌效果。关于生物相容性，根据ISO 10993-5，药物含量为11μg/cm的缝线显示出可接受的细胞毒性水平。含棕榈酸的11μg/cm氯己定涂层缝线在人体应用方面显示出最高潜力。在出现三氯生耐药性的情况下，这些新型涂层缝线可能是现有抗菌缝线（如Vicryl Plus）的替代品。氯己定已经是一种既定的口腔抗菌剂，其在抗菌缝线临床应用中的安全性和有效性应得到证实。
