Download Presoaking reticular polypropylene meshes in antiseptic solution

Presoaking reticular polypropylene meshes in antiseptic
solution inhibits the growth of Staphylococcus aureus in vitro
Pérez-Köhler B1, García-Moreno F1, Bayon Y2, Pascual G3, Bellón JM1. 1Department of Surgery, Medical and
Social Sciences, University of Alcalá, Spain. 2Covidien-Sofradim Production, Trévoux, France. 3Department of
Medicine and Medical Specialties, University of Alcalá, Spain. 1,3Networking Research Center on Bioengineering,
Biomaterials and Nanomedicine (CIBER-BBN), Spain.
Poster nº 31
Background. As a preventive measure to avoid the post-operative infection of a prosthetic mesh used for
hernia repair, the mesh may be soaked in antibacterial solution immediately before its implantation in the
host. This study assesses the use of the antiseptics, chlorhexidine (CHX) and allicin (natural antiseptic not
previously used for this purpose) vs the antibiotic vancomycin for the pretreatment of a
knitted polypropylene (PP) mesh in an in vitro model of contamination by Staphylococcus aureus (Sa).
Methods. Fragments (1x1cm) of the PP
mesh Surgipro™ were dipped in solutions
of saline (0.9%), vancomycin (40μg/mL),
allicin (1,000μg/mL), CHX (0.05%) or
allicin-CHX
(900μg/mL-0.05%)
and
incubated for 24/48/72 h on contaminated
agar plates (106 CFU Sa ATCC25923) (n=7
per time point and treatment) in the agar
diffusion test. The antimicrobial mesh
DualMesh® Plus (DM+) was used as a
positive control. At each time point,
inhibition halos were measured and
bacterial adhesion to the meshes
determined by sonication (n=5) and
scanning electron microscopy (n=2). As a
measure of treatment cytotoxicity, cell
viability was examined on rabbit skin
fibroblasts. The Mann-Whitney U test was
used for statistical analysis (mean SEM ).
u Fig 1. Zones of inhibition
created by the pretreated
meshes after 72 h of the
contamination.
t Fig 2. Diameter of the inhibition
zones (mm) created by the
meshes at the different time
points. #: PP + allicin-CHX vs PP control, PP + allicin at 24/48/72
h (p<0.01); vs PP + CHX at 24/48/72 h (p<0.05). ƒ: PP + CHX vs
PP control, PP + allicin at 24/48/72 h (p<0.01). φ: PP +
vancomycin vs PP control at 24/48/72 h (p<0.01); vs PP + allicin
at 24/48/72 h (p<0.05). δ: DM+ vs PP control, PP + allicin at
24/48/72 h (p<0.01). ζ: PP + vancomycin vs PP + allicin-CHX 24 h
(p<0.05); vs CHX at 72 h (p<0.05).
Results. At each time point, the largest inhibition halos
were observed for the mixture allicin-CHX (p<0.05). CHX
was more effective than vancomycin (p<0.05), and
q Fig 3. Bacterial colonization of the meshes
allicin allowed bacterial colonization of the inhibition
after 72 h of the contamination (x2,000).
zone 24 h after Sa contamination [Figs. 1, 2].
3.15 x 10 CFU/mesh
2.19 x 10 CFU/mesh
As observed with DM+, none of the PP meshes presoaked in
vancomycin, CHX or allicin-CHX were colonized by bacteria on their
surface. In contrast, the materials treated with saline and allicin showed
the highest bacterial counts (p<0.01) [Fig. 3]. Vancomycin was the
most innocuous treatment towards fibroblasts (p<0.001). Although
allicin and CHX were shown to be cytotoxic, their toxicity was
significantly reduced when combined (p<0.001) [Figs. 4, 5].
9
7
u Fig 4. Percentage of the
alamarBlue® reduction from cells
treated with the antibacterial
solutions vs non-treated cells, after 24h. #: Fb +
vancomycin vs Fb + allicin, Fb + CHX, Fb +
allicin-CHX (p<0.001). ƒ: Fb + allicin-CHX vs Fb +
allicin, Fb + CHX (p<0.001).
u Fig 5. Cultured skin
fibroblasts after exposition to
the antibacterial treatments
for 24h (x100).
Conclusion. The pretreatment of prosthetic meshes with antiseptics such as CHX, alone or combined with
allicin, inhibited bacterial adhesion to the mesh surface in vitro over at least 72 h, as did vancomycin and
DM+. The antiseptic combination allicin-CHX could be useful as prophylactic drugs to prevent bacterial
adhesion to a prosthetic material without compromising the initial stages of hernia repair.