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.
Highlights
Surgical site infections (SSIs) are the most common among hospital-acquired infections (HAI) and their incidence may rise up to 25% depending on the anatomical location of the surgery site [1]
Following further incubation of samples for 48 hours, in order to rule out any possible dormancy, no growth was observed around non-thermal atmospheric plasma (NTAP) treated suture samples for E. coli and S. aureus
A growth zone around each type of control sutures that were incubated on trypticase soy agar (TSA) plates, was evident, while no growth of S. aureus and E. coli was observable around the NTAP-treated sutures
Summary
Surgical site infections (SSIs) are the most common among hospital-acquired infections (HAI) and their incidence may rise up to 25% depending on the anatomical location of the surgery site [1]. SSIs increase mortality and morbidity rates, and have a remarkable impact on healthcare costs, bringing an additional 9.7 days of hospitalization and about $25.000 of additional economic burden per patient [2,3,4]. Despite the rapidly and vastly increasing medical technologies, surgeries are still an inevitable part of modern medicine. A surgical suture is a filament-shaped medical device that holds the open ends of a wound together and must withstand to normal levels of physiological mechanical stress, in order to provide sufficient mechanical support for wound closure [8]. Sutures can be classified into absorbable or non-absorbable categories based on their biodegradability, and as monofilament or multifilament (or braided) depending on their thread type [9]
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