Experimental study on the use of a chlorhexidine-loaded carboxymethylcellulose gel as antibacterial coating for hernia repair meshes
Authors
Pérez Köhler, Bárbara; Benito Martínez, Selma; Rodríguez Mancheño, Marta; García-Moreno Nisa, Francisca; Pascual González, María Gemma; [et al.]Identifiers
Permanent link (URI): http://hdl.handle.net/10017/59403DOI: 10.1007/s10029-019-01917-9
ISSN: 1265-4906
Date
2019Funders
Ministerio de Ciencia, Innovación y Universidades
Bibliographic citation
Hernia : the journal of hernias and abdominal wall surgery, 2019, v. 23, n. 4, p. 789-800
Keywords
Antimicrobial coating
Carboxymethylcellulose
Chlorhexidine
Hernia
Mesh coating
Polypropylene
Description / Notes
21 p.
Project
info:eu-repo/grantAgreement/MICIN//SAF2017- 89481-P/ES//
Document type
info:eu-repo/semantics/article
Version
info:eu-repo/semantics/acceptedVersion
Rights
Attribution 4.0 International (CC BY 4.0)
Access rights
info:eu-repo/semantics/openAccess
Abstract
Purpose: Biomaterials with an antimicrobial coating could avoid mesh-associated infection following hernia repair. This study assesses the use of a chlorhexidine-loaded carboxymethylcellulose gel in a model of Staphylococcus aureus mesh infection. Methods: A 1% carboxymethylcellulose gel containing 0.05% chlorhexidine was prepared and tested in vitro and in vivo. The in vitro tests were antibacterial activity (S. aureus; agar diffusion test) and gel cytotoxicity compared to aqueous 0.05% chlorhexidine (fibroblasts; alamarBlue). For the in vivo study, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (n = 15) and inoculated with 0.25 mL of S. aureus ( 106 CFU/mL). Defects were repaired with a lightweight polypropylene mesh (Optilene) without coating (n = 3) or coated with a carboxymethylcellulose gel (n = 6) or chlorhexidine-loaded carboxymethylcellulose gel (n = 6). Fourteen days after surgery, bacterial adhesion to the implant (sonication, immunohistochemistry), host tissue incorporation (light microscopy) and macrophage reaction (immunohistochemistry) were examined. Results: Carboxymethylcellulose significantly reduced the toxicity of chlorhexidine (p < 0.001) without limiting its antibacterial activity. While control and gel-coated implants were intensely contaminated, the chlorhexidine-gel-coated meses showed a bacteria-free surface, and only one specimen showed infection signs. The macrophage reaction in this last group was reduced compared to the control (p < 0.05) and gel groups. Conclusions: When incorporated in the carboxymethylcellulose gel, chlorhexidine showed reduced toxicity yet maintained its bactericidal effect at the surgery site. Our findings suggest that this antibacterial gel-coated polypropylene meshes for hernia repair prevent bacterial adhesion to the mesh surface and have no detrimental effects on wound repair.
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