Abstract
Implant-associated infections and non-absorbing materials are two important reasons for a second surgical procedure to remove internal fixation devices after an orthopedic internal fixation surgery. The objective of this study was to produce an antibacterial and absorbable fixation screw by adding gentamicin to silk-based materials. The antibacterial activity was assessed against Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) in vitro by plate cultivation and scanning electron microscopy (SEM). We also investigated the properties, such as the mechanical features, swelling properties, biocompatibility and degradation, of gentamicin-loaded silk-based screws (GSS) in vitro. The GSS showed significant bactericidal effects against S. aureus and E. coli. The antibacterial activity remained high even after 4 weeks of immersion in protease solution. In addition, the GSS maintained the remarkable mechanical properties and excellent biocompatibility of pure silk-based screws (PSS). Interestingly, after gentamicin incorporation, the degradation rate and water-absorbing capacity increased and decreased, respectively. These GSS provide both impressive material properties and antibacterial activity and have great potential for use in orthopedic implants to reduce the incidence of second surgeries.
Highlights
Features, biocompatibility, ability to promote bone remodeling and environmental stability[21]
Our research indicated that silk fibroin partly promoted the growth of Staphylococcus aureus (S. aureus), which may be the major disadvantage of the use of these screws as a fixation device
Most clinical isolates of S. aureus and gram-negative rods that are thought to be mainly responsible for implant-associated infections in orthopedic surgery are sensitive to gentamicin[42]
Summary
Features, biocompatibility, ability to promote bone remodeling and environmental stability[21]. Like all biomaterials, silk-based screws may carry an elevated risk of implant-associated infections because of the formation of bacterial biofilms[23,24,25,26]. Several biomaterial surface modifications have been proposed to impart silk fibroin with antibacterial properties, such as combination with chitosan[28], chemical attachment of antimicrobial peptides[29] and loading with silver nanoparticles[30,31]. In clinical applications, internal fixation materials must be autoclaved for sterilization, and high temperatures may affect the antibacterial properties of antimicrobial peptides[29,32]. We expected to obtain a resorbable and antimicrobial fixation device with high mechanical strength and impressive biocompatibility to reduce the risk of second surgery caused by infection and other complications
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