Comparison of Efficacy of Povidone-Iodine, Ethanol, and an Aerosol Formulation of Silver Sulfadiazine in Controlling Microbial Burden on Sutures From Clean Surgeries

Abstract

In the surgical suture, the implanted thread can be a source of microbial contamination. Implanted materials are frequently described as being substrates prone for biofilm development provoking surgical site infections (SSIs). Treatment of post-surgical wounds with different topical antimicrobial agents is a current practice applied to every patient. However, to date there is little evidence on the efficacy of different antiseptic treatments on suture materials in preventing environmental or skin bacterial adhesion and further infection. Here, we compared the ability of an aerosol formulation of silver sulfadiazine (AF-SSD) and of two of the most frequently used topical treatments, povidone-iodine and ethanol, in eradicating or controlling the microbial contamination of suture threads in patients that have undergone clean surgeries. Post-surgical suture threads treated with AF-SSD showed a significantly reduced proportion of contaminated samples containing viable microbial cells compared to those treated with povidone-iodine or ethanol. Furthermore, those samples which were positive for bacterial growth showed a lesser number of viable cells in AF-SSD treated sutures than those treated with povidone-iodine or ethanol. Confocal Laser Scanning Microscopy showed that AF-SSD treated post-surgical sutures presented significantly less attached microbial cells than povidone-iodine and ethanol, with scarce observable microbial cells on the surface of the suture. Taken together, the results suggest that AF-SSD is more effective than the other two antiseptics, and a potential improvement in reducing the microbial burden of implanted materials such as the suture thread.