Coated Surgical Sutures: Nanoparticles and nanocomposite as coating materials for absorbable and nonabsorbable wound closure devices

Coated Surgical Sutures: Nanoparticles and nanocomposite as coating materials for absorbable and nonabsorbable wound closure devices | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Coated Surgical Sutures: Nanoparticles and nanocomposite as coating materials for absorbable and nonabsorbable wound closure devices heba shebl, rehab abdallah, omnia abdallah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5945870/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Upgrading the surgical sutures, as the main wound closure device, is essential. The evolution of bacterial resistance and the plummeting of antibiotics have directed research toward augmented sutures. Nanotechnology has provided answers to these concerns. The use of bacterial isolates as bio-factory for synthesized silver nanoparticles (AgNPs) and silver nanocomposites via a one pot ex situ method provides environmentally friendly silver nanocomposites in addition to the use of chitosan and polyvinyl alcohol polymers as carriers. Transmission electron microscopy (TEM) and zeta potential analysis revealed spherical negatively charged AgNPs. These nanoparticles and nanocomposites were used as coatings for absorbable vicryl and nonabsorbable silk surgical sutures. Atomic force microscopy (AFM) 3D images of these coated sutures showed a significant decrease in surface roughness with improved surface topography, specifically with chitosan-silver (CS-Ag) vicryl coated sutures with effective attachment of the nanocomposite and nanoparticles thin film on the suture surface. Field emission scanning electron microscopy with energy dispersive x-ray spectroscopy (FE-SEM/EDX) analysis showed the significant presence of the thin film of coating materials on the surface of the sutures and the significant elemental presentation of Ag. Vicryl and silk coated CS-Ag sutures showed significant antibacterial and antibiofilm activities against both gram positive and gram negative bacterial isolates. AgNPs coated silk and vicryl sutures recorded the lowest amounts of Ag ions at 0.03–0.45 ppm released after 14 days, while polyvinyl alcohol-silver (PVA-Ag) coated ones showed the highest rates at 0.75–0.93 ppm. Biological sciences/Biological techniques Biological sciences/Biotechnology Biological sciences/Microbiology Physical sciences/Nanoscience and technology Coated Sutures Silver nanoparticles Nanocomposite Atomic force microscopy Field emission scanning electron microscopy Antibacterial Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Introduction Surgical sutures are among the most important surgical devices used for wound closure. This type of filament-shaped device is one of the oldest and most common surgical device and cannot be outdated by modern technology in the medical field 1 . However, it can be augmented with other properties to increase its efficiency and limit its drawbacks. The main function of sutures is closure of wounds and incision sites, and they can be classified according to their absorbability and biodegradability. They are made of dissimilar materials with variable absorbability ranges such as silk, nylon, cut gut and vicryl sutures 2 . One of the major suture complications is the postsurgical infection (PSI) or site surgical infection (SSI) because bacterial growth and biofilm formation cause postoperative tissue inflammation surrounding the surgical site 3 , 4 . Sutures serve as a niche for bacterial attachment, proliferation and eventually biofilm formation. This major drawback significantly increases the infection risk by 10000 times. SSI increases mortality rates and is considered the most common hospital acquired infection. Furthermore, it strongly impacts the number of days of hospitalization and increases the cost of medical services per patient 5 , 6 . In 2011, the WHO reported that SSI was estimated to affect more than 20% of patients as postsurgical complication, increasing the use of systemic and localized antibiotics, which are associated with rouge and drug-resistant bacteria 7 . This leads to a vicious cycle of repeated drug-resistant infections and the extreme use of antibiotics. Surgical sutures can be sterilized by autoclaving or chemical disinfection, nevertheless, these actions cannot guarantee the prevention of microbial attachment and growth once the sutures are used at surgical sites 8 . Bacterial growth and biofilm formation are complex processes at surgical sites. Both processes start with bacterial adhesion to suture materials after the implantation procedure and, consequently, proliferation and infection. Therefore, recent studies have focused on the initial prevention of this adhesion step and hence preventing the formation of biofilms with virulent and multi- drug resistant (MDR) bacteria 1 , 9 . Recently, coating surgical sutures with antibiotics has been adopted to add antimicrobial activity to sutures by limiting their susceptibility to bacterial growth and lowering surgical site complications. Multiple sutures have been improved by different antibiotics such as ciprofloxacin, levofloxacin hydrochloride, octenidine and chlorhexidine to reduce bacterial growth. However, this step faces the emergence and spread of MDR bacteria, causing an abbreviated period of bacterial inhibition and increasing the risk of wound healing and inflammatory reactions 10 , 11 . Therefore, the demand for an effective alternative was proposed. Currently, the direct delivery of antimicrobial products from sutures to scared tissue is used and targeted by many studies. Nanoparticle (NP) and nanocomposite (NC) coatings are the most developed alternatives to tackle microbial growth associated with surgical sites 12 . Coating surgical sutures has been reported as an effective strategy to increase their ability to fight microbial growth and prevent the formation of biofilms. Various physical, chemical, and biological pathways can be used to synthesize NPs. Biologically synthesized NPs can be achieved via the use of bacterial isolates as bio factories for the synthesis of stabilized NPs, where the bacterial cell structure provides an effective metabolic pathway for the bio-formation of NPs with well-defined shapes, high reactivity, and water solubility properties 9 , 13 . These findings suggested that biologically synthesized NPs are the favored choice for many biomedical applications 13 . Silver nanoparticles (AgNPs) are among the most promising antimicrobial agents with a wide range of applications, such as in wound and burn healing, as well as in bone and dental implants 14 . These nanoparticles can be bound to polymers that form NCs with antimicrobial properties. Polyvinyl alcohol (PVA) and chitosan (CS) have been integrated into many applications because they are biodegradable and biocompatible. PVA is FDA approved for use in the food industry and medical applications without side effects. Furthermore, CS is a natural polymer that can be hydrolyzed by a human enzymatic system into harmless products. Both PVA and CS can be used as biological scaffolds for nanoparticles, leading to a wider scope of applications 13 , 15 . In our study, biologically synthesized AgNPs were used, and the sol-gel coating method was employed to coat nonabsorbable silk and absorbable vicryl surgical sutures. Coated sutures were evaluated for their antimicrobial and antibiofilm activities against various bacterial isolates. Materials and methods Biosynthesis of silver nanoparticles and silver nanocomposites A schematic diagram of experimental setup is shown on Fig. 1 . Starting with AgNPs synthesis, which was achieved via the use of Enterobacter cloacae Ism 26 (KP988024). Briefly, a bacterial culture was inoculated in 100 mL of nutrient broth medium, incubated at 35°C for 24 h, and then centrifuged for 15 min. AgNO 3 (1 mM) was mixed with the supernatant bacterial cell lysate and incubated at 35°C for 24 h. Lyophilized AgNPs were obtained via an Edwards model RV5 (England). These biologically synthesized NPs were used at different concentrations (W/V%) (0.1% (C1), 0.2% (C2), 0.3% (C3), 0.4%(C4), 0.5%(C5) and 0.6% (C6)) in further experiments. The synthesized AgNPs were mixed with PVA or CS separately to form silver nanocomposites. Briefly, 2 g of PVA (Alpha Cheimeka, India) was added to 20 ml of deionized water and magnetically stirred on a hot plate at 90°C for 3 h. Then, different concentrations of the biosynthesized AgNPs were added and stirred for another 4 h (from C1- C6) (w/v)). CS (0.4 g) was added to 20 ml of acetic acid (1%) and magnetically stirred for 1 h at 60°C; then, (from C1- C6) (w/v) AgNPs were added, and the mixture was further stirred for 2 h. These nanocomposite solutions were used for further experiments. Pure PVA and CS solutions were used as controls 15 . Sol-gel coating of AgNPs and silver nanocomposites on surgical sutures Vicryl (PGA-absorbable braided 4 − 0, Assucryl sutures, Switzerland) and silk (nonabsorbable braided 3 − 0, Assut medical sutures, Switzerland) sutures were immersed for 24 hrs at different AgNPs concentrations (C1- C3) (AgNPs, PVA-Ag, CS-Ag) for vicryl and (C1- C6) (AgNPs, PVA-Ag, CS-Ag) for silk. Uncoated sutures and sutures coated with pure solutions of PVA and CS were used as control. After 24 hrs, all the samples were grasped with sterilized tweezers and left to air dry in a laminar flow hood overnight. Finally, the coated wires were placed in an oven at 40°C for 10 min as a final step before use in further experiments. All the procedure steps were conducted under laminar flow, and all the samples were separated and sealed in sterilized Eppendorf tubes until the next experiments were performed 13 , 16 . Characterization of silver nanoparticles and coated sutures Biologically synthesized AgNPs were characterized via UV-Vis spectrometry to detect specific peaks (400–450 nm) dynamic light scattering (DLS) and the zeta potential to determine the particle size and surface charge using a PSS-NICOMP particle sizer 380ZLS (Malvern Instruments Ltd.). Accurate nanoparticle shape and size in nm were identified via transmission electron microscopy ( TEM) (JOEL JEM-1010) at 80 kV at the Regional Centre for Mycology and Biotechnology (RCMB) of Al-Azhar University 15 . The surface topography and roughness of the uncoated and coated vicryl and silk sutures were determined via atomic force microscopy (AFM) (NanoSurf C3000, Gräubernstrasse, Liestal, Switzerland) operating in phase contrast mode. AFM provides 3D images with measurements of surface roughness, and irregularity in defined measured areas. The average thickness, roughness (Ra), and maximum roughness depth (Rq) were calculated for uncoated and coated sutures using image processing and data analysis software supplied with the AFM 4 . Furthermore, coated, and uncoated sutures were examined by field emission scanning electron microscopy with energy dispersive X-ray spectroscopy (FE-SEM/EDX) (QUANTA, FEG 250, Thermo Scientific) operating at an accelerating voltage of 30 kV to visualize the surface changes and detect the extent of the coating and its efficacy on the suture surface for all the tested coating materials vs. the uncoated control suture samples. EDX analysis was employed to calculate and identify the composition and elemental analysis of each sample surface. The suture samples were mounted on metallic copper stubs and fixed with carbon conductive tape at a standard tilt angle, and FE-SEM photomicrographs were taken from the surface at various magnifications 7 , 17 . Uncoated sutures served as controls throughout the experiments. Antibacterial activity The antibacterial activity of all the coated and uncoated sutures was evaluated using an agar diffusion test according to the Clinical and Laboratory Standards Institute (CLSI). This test was performed against clinically relevant gram-positive Staphylococcus aureus (S1), Streptococcus mutans (St1), and Enterococcus faecalis (E1) and the gram-negative bacterial microorganisms Acinetobacter baumannii (A1), Acinetobacter baumannii (A2), and Pseudomonas aeruginosa (P1). The samples were placed on Muller-Hinton agar (MHA) plates inoculated with 10 6 CFU/ml bacterial cultures and then silk and vicryl sutures were placed on each plate (uncoated control, PVA-coated, CS-coated, AgNPs-coated, PVA-Ag coated, and CS-Ag coated). Finally, the inoculated plates were incubated at 37°C for 24 h and the diameter of the inhibition zone (mm) was measured; the results are reported as the mean ± standard deviation 13 , 15 , 16 . Antibiofilm activity Coated and uncoated silk and vicryl sutures were assessed for their ability to inhibit biofilm formation 13 , 15 . Acinetobacter baumannii (A1), and Pseudomonas aeruginosa (P1) were used for this test. Using 20 ml of tryptic soy broth (TSB) (Merck, Germany) as culture media supplemented with 1% glucose, these biofilm forming bacteria were grown at 37°C for 24 h. Using a 96-well microtiter plate, 200 µl of each diluted bacterium (1:100) was inoculated into the wells that were previously supplied with coated and uncoated sutures. Microtiter plates were incubated at 37°C for 24 h. Then, each well was washed with phosphate buffered saline (pH 7.2) and dried for 30 min. The next step was the addition of crystal violet (CV) solution (0.1% w/v), after which the plates were washed and dried. Finally, 100 µl of ethanol (96%) was added to each well to extract the stained bound biofilm, and the CV absorbance optical density (OD) was measured and graphed at 490 nm with a microplate Reader (ELx808™ Absorbance, Biotek, USA). Biofilm inhibition can be measured, and the percentage of inhibition was calculated using the following equation: % inhibition = 1– (OD of coated sutures / OD of negative control) x 100 Where, the OD of the coated sutures is the optical density of the sample. The OD of the negative control was the control for biofilm-forming bacteria. Quantification of released AgNPs from coated sutures The amount of AgNPs released from the coated sutures was determined via Atomic Absorption Spectrometry (AAS) (Perkin Elmer 3100) after storage in phosphate-buffered saline for 14 days. The coated sutures were digested in nitric acid, and the concentration of AgNPs released was quantified. Statistical analysis The SPSS standard software package was used for data analysis. One-way analysis of variance (ANOVA) with Tukey’s post- hoc test was used to compare the effects between groups (n = 5). The data are presented as the means ± standard deviation (SDs). The level of significant difference was set at p < 0.05. Results Characterization of the nanoparticles and coated sutures AgNPs synthesized from Enterobacter cloacae Ism 26 (KP988024) were characterized, and their morphology was detected. The TEM micrographs in Fig. 2 showed rounded to spherical shaped nanoparticle sizes ranging from 33 to 14 nm, with an average size of 15 nm. The biologically synthesized AgNPs were negatively charged with a zeta potential of -34 mV as shown in Fig. 2 . Using the sol-gel coating technique, silk and vicryl sutures were immersed in various concentrations of AgNPs and nanocomposites. AFM was performed for the coated and uncoated sutures via different fitting techniques to model the coating data and results. 3D image pseudocolored graphs are shown in Figs. 3 and 4 , which reveal that the thickness and surface roughness change according to the different coating materials. The variability in thickness varied from silk to vicryl sutures and from one coating material to another. For the vicryl sutures, all the coating layers varied in thickness, with average thickness of 19.7, 25.7, and 42.1 nm, for the CS-Ag, PVA-Ag, and AgNPs samples, respectively. There was no major difference between the different coating layers on the vicryl sutures. However, by measuring the average Ra values, the data revealed a significant decrease in roughness, where uncoated vicryl sutures had an Ra value of 12.6 nm, and coated sutures had Ra values of 4.71, 7.09 and 2.80 nm for CS-Ag, PVA-Ag and AgNPs, respectively. Furthermore, the Rq values significantly decreased, where uncoated vicryl sutures had an Rq value of 14.13 nm, and coated sutures had much lower values of 5.37, 8.11 and 3.67 nm for CS-Ag, PVA-Ag and AgNPs, respectively. These tests and results were also performed and recorded on silk sutures. The thickness of the coating layers varied widely on average at 27.3, 43.4 and 600 nm for CS-Ag, PVA-Ag, and AgNPs, respectively. The type of coating material used on the silk sutures influenced the results. By measuring the average Ra values, the data were also highly influenced by the coating material type, where the control uncoated silk sutures had an Ra value of 2.3 nm, and the CS-Ag coating had an average value of 1.87 nm. However, the PVA-Ag coating increased the Ra value to 5.7 nm, whereas the AgNPs coating significantly increased the Ra value to 124.03 nm. The Rq values were also recorded with 3.01 nm for the uncoated silk sutures, a slightly lower value for CS-Ag at 2.20 nm and an increased value for the PVA-Ag coating. The AgNPs coating showed a remarkably high Rq value at 146.7 nm. Field emission scanning electron microscopy (FE-SEM)/ energy dispersive x-ray spectroscopy (EDX) The FE-SEM/EDX micrographs of the uncoated and coated sutures exposed the surface changes when the surfaces were coated with PVA-Ag, CS-Ag or AgNPs. These images confirmed the coverage of the coating layer on the surface of the silk and vicryl sutures as shown in Figs. 5 and 6 . By comparing uncoated silk and vicryl sutures with coated ones, the impact of coating with nanoparticles and nanocomposites was photographed, and all the coated sutures showed complete coverage of the material used on the suture surface by bright spots imbedded within the braided structure of the sutures. EDX analysis was used to examine the elemental composition of the coated sutures, which displayed the presence of major elements such as carbon (C), nitrogen (N) and oxygen (O), which are the main components of silk and vicryl sutures in addition to CS and PVA as presented in Figs. 7 and 8 . Furthermore, the elemental presence of silver (Ag) was evident in all the coated sutures confirming the presence and attachment of silver ions on the surface of the sutures. Additionally, the presence of Ag was limited by the use of PVA-Ag coated silk sutures and was much greater with the use of vicryl-coated sutures. However, its presence was more significant with the CS-Ag coated silk sutures that showed the highest number of bright spots indicating the presence and attachment of AgNPs and much lower with the vicryl-coated ones. For the AgNPs coated for both types of sutures, the amount of Ag was high. Antibacterial activity The antibacterial activities of the coated and uncoated silk and vicryl sutures were evaluated at different concentrations, as shown in Figs. 9 and 10 . The antimicrobial effect of vicryl-coated sutures at lower concentrations was more significant than that of silk coated sutures, where at lower concentrations of AgNPs, vicryl-coated sutures have caused a wider range of inhibition zones against all tested gram positive and gram-negative bacteria. With respect to vicryl sutures, the uncoated sutures and PVA coated sutures showed no antibacterial effects at all concentrations. However, the AgNPs and PVA-Ag coated sutures showed antimicrobial activity at C3 only, as lower concentrations did not inhibit any of the bacteria tested. However, the CS-coated sutures significantly inhibited all bacterial isolates, and the CS-Ag coated sutures exhibited significant antimicrobial activity that was directly proportional to the AgNPs concentration. As shown in Figs. 11 and 12 , the following inhibition zones were recorded: gram positive Staphylococcus aureus (S1), 25 ± 0.70 mm; Streptococcus mutans (St1), 17.8 ± 1.30 mm; and Enterococcus faecalis (E1), 27.2 ± 2.16 mm; and gram negative bacterial isolates Acinetobacter baumannii (A1), 17.6 ± 0.89 mm; Acinetobacter baumannii (A2), 17.8 ± 0.44 mm; and Pseudomonas aeruginosa (P1), 29.6 ± 1.10 mm. Silk sutures, both coated and uncoated, showed no antimicrobial activity at C1 or C2 with zero inhibition zones. However, as the AgNPs and nanocomposites concentrations increased, antimicrobial activity was observed. At C3, the number of bacterial species affected by the concentration increase was noteworthy. The most significant concentrations for the coated silk sutures were C5 and C6, and the inhibition effect reached a steady value with intersecting inhibition zones on the MHA plates. CS-Ag coated silk at C6 showed the most significant antimicrobial activity against all the gram-positive Staphylococcus aureus (S1) 25.4 ± 0.9 mm; Streptococcus mutans (St1) 10.8 ± 1 mm; and Enterococcus faecalis (E1) 20 ± 1.4 mm; and the gram-negative bacterial isolates Acinetobacter baumannii (A1) 15 ± 0.7 mm; Acinetobacter baumannii (A2) 28.4 ± 0.8 mm, and Pseudomonas aeruginosa (P1) 20 mm in size. Antibiofilm activity Coated and uncoated silk and vicryl sutures were assessed for their antibiofilm activity against 2 of the most common biofilms forming bacterial isolates, Acinetobacter baumannii and Pseudomonas aeruginosa (A1 and P1), as shown in Fig. 13 . The results showed that the PVA coated vicryl or silk sutures had the highest optical density, even greater than that of the uncoated silk or vicryl sutures, and the lowest biofilm inhibition among all the tested sutures. The coated groups, CS, CS-Ag, PVA-Ag and AgNPs, of silk and vicryl sutures presented a low optical density, indicating a high percentage of biofilm inhibition. The most significant inhibition was observed at C3 against Acinetobacter baumannii (A1) and Pseudomonas aeruginosa (P1), with the use of CS-Ag coated vicryl sutures causing 89.2 ± 3.1% and 78.3 ± 5.4%, respectively. The silk coated sutures needed a much higher concentration (C6) of AgNPs and nanocomposites to cause biofilm inhibition (86.4 ± 1.2% and 72.9 ± 2.3%, respectively) and optical density like those of the vicryl coated sutures. Release of silver ions from coated sutures The release of Ag from each coated silk and vicryl sutures was calculated after 7 and 14 days. The AAS results showed that the Ag ions released were affected by type of suture and the coating material. As for the silk coated samples, after 7 days they showed the highest amount of Ag ions released with no significant change from that released after 14 days. Amount of Ag ions released ranged from 0.123 to 0.75 ppm for all silk coated sutures and from 0.03 to 0.93 ppm for all vicryl coated suture, along the 14 days. However, the PVA-Ag coated samples, either vicryl or silk sutures showed the highest amount of Ag ions released reaching 0.75 and 0.93 ppm, respectively. Discussion Biogenically synthesized AgNPs were perused in this study. The microorganism, Enterobacter cloacae Ism 26 (KP988024), mediates the nucleation and growth of AgNPs 15 . This pathway provides a spherical controlled shape, low aggregation rates, high homogeneity with a low polydispersity index (PI), highly stable nanoparticles and negatively charged nanoparticles that are used in addition to the nanocomposite as a coating layer on absorbable vicryl and nonabsorbable silk sutures. These sutures have been used for wound closure in oral and maxillofacial area such as after tooth extraction, buccal and/or lingual flaps, and flap closure in edentulous ridge. The use of nanoparticles has been reported in other studies 2 , 8 , 18 , which have used various types of sutures to increase the effectiveness of nanomaterials coating and their impact on the future of one of the most ancient wound closure devices. In our study, we demonstrated the ability of vicryl and silk sutures to function and coat them with AgNPs, CS-Ag or PVA-Ag. The AFM results confirmed that coating a surgical suture can strongly influence surface roughness, causing a significant decrease in surface roughness, which explains the ability of the coated sutures to resist bacterial colonization and their significant efficacy against the tested bacterial isolates. Here, we can see that the antimicrobial results were complementary and confirmatory to the AFM results. Whereas the surface roughness decreased, bacterial accessibility to the suture surface decreased, which was, reflected by an increase in the bacterial inhibition zone and a decline in biofilm formation. These findings indicate the direct proportionality between surface roughness and bacterial attachment ability. These results can explain the extremely high bacterial optical density observed on uncoated silk and vicryl sutures and show that because a barrier can act as an insulator from bacterial attachment, it needs to be augmented with antimicrobial capabilities. This was confirmed by observing the state of PVA-coated sutures which acted as niches for bacterial colonization and did not cause any form of bacterial inhibition; in contrast, they act as attractive agents that amplify infection and colonization. Similar results were recorded in previous studies 6 , 19 , 20 . The presence of encapsulated nanomaterial and nanoparticles that function as antimicrobial agents, effectively attached to surgical devices, has significantly improved the ability of these devices to resist bacterial attachment and can be used as a superior choice to overcome current multidrug-resistant bacterial infections that infect foreign medical devices used on wounds 1 , 9 . FE-SEM/EDX of the PVA-Ag coated vicryl or silk sutures displayed a thick layer of coating that smoothed the surface of the sutures, but this alteration in surface morphology was not attributed to more AgNPs on the suture surface or higher antimicrobial activity, indicating the possibility of high affinity of PVA for sutures without significant properties, as the presence of this type of coating has led to more bacterial attachment and significantly decreased suture antibiofilm and antibacterial activities. On the contrary, the CS-Ag coated silk sutures exhibited a much thicker layer of coating with significant impact on bacterial growth and attachment, leading to significant results. This thin coating layer acted as a barrier and gave the AgNPs access to the bacterial cells in the surrounding environment to eliminate them and cause the greatest inhibition zones and biofilm inhibition. As a coating layer, only the AgNPs produced bright spots on the suture surfaces of both the silk and the vicryl sutures, as indicated by the antibacterial activity, which was significantly enhanced upon the addition of CS. Similar results were reported in previous studies 16 , 18 , 21 . The accessibility of AgNPs is highly influenced by their scaffold. Compared with nanoparticles alone, the ability of CS and PVA to carry AgNPs increased the inhibition zone and antibiofilm effectiveness. Furthermore, the antimicrobial activity of CS alone cannot be forgotten and has been multiplied by the addition of AgNPs, resulting in the highest rates of bacterial and biofilm inhibition 4 , 22 , 23 . Therefore, augmenting nanoparticles is an essential step in our research, as implementing lower concentrations of nanomaterials in addition to an effective carrier can channel these particles to their designated target. The Addition of this thin layer of coating on the suture surface has positively impacted the fight against MDR bacteria and SSI. Spherical-shaped nanoparticles have significantly greater antimicrobial effects on various bacterial species. The release of silver ions from both sutures has impacted the antimicrobial and antibiofilm activity but these effects were augmented upon the addition of CS, which has retained and sustained the coated sutures abilities. AgNPs have broad-spectrum antibacterial activity against gram positive and gram-negative bacteria, and their incorporation into medical devices can lead to increased antimicrobial and antibiofilm activities. The nanostructured silver has a high surface-to-volume ratio, leading to high efficacy in anchoring to the microorganism’s cell structure and highly penetrating the bacterial cell wall, forming free radicals, damaging DNA, causing structural changes and finally causing bacterial cell death 15 . AgNPs can release Ag ions from silver clusters, and this continuous release ensures the durability of their antimicrobial activity. They are highly accessible to cells because of their nanosize range; therefore, their antimicrobial activity is uniquely high 9 , 15 . Declarations Data availability The data are available from the corresponding authors upon reasonable request. Acknowledgments The authors declare that no funds, grants, or other support was received during the preparation of this manuscript. Author information Authors and affiliations Microbiology Department, Faculty of Dentistry, Misr International University, Cairo, Egypt Omnia Mohamed Abdallah and Heba Rafaat Shebl Oral and maxillofacial surgery Department, Faculty of Dentistry, Misr International University, Cairo, Egypt Rehab Ahmed Soliman Authors' contributions All the authors contributed to the study conception and design. OMA wrote the first draft of the manuscript, and all the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. References Li, Y. et al. Advances, challenges, and prospects for surgical suture materials. Acta Biomater. 168 , 78–112 (2023). Guadarrama-Reyes, S. C., Scougall-Vilchis, R. J., Morales-Luckie, R. A., Sánchez-Mendieta, V. & López-Castañares, R. Antimicrobial Effect of Silk and Catgut Suture Threads Coated with Biogenic Silver Nanoparticles. in Silver Nanoparticles - Fabrication, Characterization and Applications (InTech, 2018). doi:10.5772/intechopen.75074. Edmiston, C. E. et al. Microbiology of explanted suture segments from infected and noninfected surgical patients. J. Clin. Microbiol. 51 , 417–421 (2013). Syukri, D. M., Nwabor, O. F., Singh, S. & Voravuthikunchai, S. P. Antibacterial functionalization of nylon monofilament surgical sutures through in situ deposition of biogenic silver nanoparticles. Surf. Coatings Technol. 413 , 127090 (2021). Sampathi, S., Tiriya, P. K., Dodoala, S., Junnuthula, V. & Dyawanapelly, S. Development of Biocompatible Ciprofloxacin–Gold Nanoparticle Coated Sutures for Surgical Site Infections. Pharmaceutics 14 , 1–14 (2022). Obermeier, A. et al. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). PLoS One 13 , 1–20 (2018). Syukri, D. M. et al. Antibacterial-coated silk surgical sutures by ex situ deposition of silver nanoparticles synthesized with Eucalyptus camaldulensis eradicates infections. J. Microbiol. Methods 174 , 105955 (2020). Dubas, S. T., Wacharanad, S. & Potiyaraj, P. Tunning of the antimicrobial activity of surgical sutures coated with silver nanoparticles. Colloids Surfaces A Physicochem. Eng. Asp. 380 , 25–28 (2011). Abdallah, O. M., Shebl, H. R., Abdelsalam, E. & Mehrez, S. I. The impact and safety of encapsulated nanomaterials as a new alternative against carbapenem resistant bacteria. a systematic review. World J. Microbiol. Biotechnol. 40 , 1–12 (2024). Potluri Leela Ravishankar, Vandana Vijayan, Sunanda K Rao, Saravanan A Vadivelu, D. N. & Surya Teja1. In Vitro Antibacterial Efficacy of Sutures Coated With Aloe vera and Ciprofloxacin: A Comparative Evaluation. J. Pharm. Bioallied Sci. 11 , 164–168 (2019). Arora, A., Aggarwal, G., Chander, J., Maman, P. & Nagpal, M. Drug eluting sutures: A recent update. J. Appl. Pharm. Sci. 9 , 111–123 (2019). Edis, Z., Bloukh, S. H., Sara, H. A. & Azelee, N. I. W. Antimicrobial Biomaterial on Sutures, Bandages and Face Masks with Potential for Infection Control. Polymers (Basel). 14 , (2022). Abdallah, O. M., Sedky, Y. & Shebl, H. R. Comprehensive evaluation of the antibacterial and antibiofilm activities of NiTi orthodontic wires coated with silver nanoparticles and nanocomposites: an in vitro study. BMC Oral Health 24 , 1345 (2024). Noronha, V. T. et al. Silver nanoparticles in dentistry. Dent. Mater. 33 , 1110–1126 (2017). Abdallah, O. M. Antibacterial , antibiofilm and cytotoxic activities of biogenic polyvinyl alcohol-silver and chitosan-silver nanocomposites. 1–9 (2020). Monroy Caltzonci, D. A. et al. Antimicrobial and Cytotoxic Effect of Positively Charged Nanosilver-Coated Silk Sutures. ACS Omega (2024) doi:10.1021/acsomega.4c01257. Zhou, Y. L., Yang, Q. Q., Zhang, L. & Tang, J. B. Nanoparticle-coated sutures providing sustained growth factor delivery to improve the healing strength of injured tendons. Acta Biomater. 124 , 301–314 (2021). Blinov, A. V. et al. Surface-Oxidized Polymer-Stabilized Silver Nanoparticles as a Covering Component of Suture Materials. Micromachines 13 , (2022). Ding, Y. Q. et al. A reduced graphene oxide-coated conductive surgical silk suture targeting microresistance sensing changes for wound healing. Sci. China Technol. Sci. 67 , 3499–3512 (2024). Ercan, U. K. et al. Prevention of bacterial colonization on nonthermal atmospheric plasma treated surgical sutures for control and prevention of surgical site infections. PLoS One 13 , 1–24 (2018). Baygar, T. et al. Fabrication of a Biocompatible Nanoantimicrobial Suture for Rapid Wound Healing after Surgery. ACS Omega 9 , 22573–22580 (2024). Guadarrama-Reyes, S. C., Scougall-Vilchis, R. J., Morales-Luckie, R. A., Sánchez-Mendieta, V. & López-Castañares, R. Antimicrobial Effect of Silk and Catgut Suture Threads Coated with Biogenic Silver Nanoparticles. Silver Nanoparticles - Fabr. Charact. Appl. (2018) doi:10.5772/intechopen.75074. Yang, Y. et al. Bacterial inhibition potential of quaternised chitosan-coated VICRYL absorbable suture: An in vitro and in vivo study. J. Orthop. Transl. 8 , 49–61 (2017). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 13 Mar, 2025 Reviews received at journal 13 Mar, 2025 Reviews received at journal 28 Feb, 2025 Reviewers agreed at journal 04 Feb, 2025 Reviewers agreed at journal 04 Feb, 2025 Reviewers invited by journal 04 Feb, 2025 Editor assigned by journal 04 Feb, 2025 Editor invited by journal 04 Feb, 2025 Submission checks completed at journal 04 Feb, 2025 First submitted to journal 02 Feb, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5945870","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":411482344,"identity":"4e227b1b-06a2-4d77-8a8c-6686190b1538","order_by":0,"name":"heba shebl","email":"","orcid":"","institution":"Misr International University","correspondingAuthor":false,"prefix":"","firstName":"heba","middleName":"","lastName":"shebl","suffix":""},{"id":411482345,"identity":"1dcf38a1-6e3a-4c20-ae13-182f27e95127","order_by":1,"name":"rehab abdallah","email":"","orcid":"","institution":"Misr International University","correspondingAuthor":false,"prefix":"","firstName":"rehab","middleName":"","lastName":"abdallah","suffix":""},{"id":411482346,"identity":"75387db2-243f-4a95-8b0c-aa20ddc35769","order_by":2,"name":"omnia abdallah","email":"data:image/png;base64,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","orcid":"","institution":"Misr International University","correspondingAuthor":true,"prefix":"","firstName":"omnia","middleName":"","lastName":"abdallah","suffix":""}],"badges":[],"createdAt":"2025-02-02 13:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5945870/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5945870/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-07558-6","type":"published","date":"2025-07-01T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75589434,"identity":"49488ae6-6282-42c2-95ef-aef33e811d25","added_by":"auto","created_at":"2025-02-06 06:55:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139219,"visible":true,"origin":"","legend":"\u003cp\u003eA schematic diagram of experimental setup.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/40361d8a47aefa873c7283dc.png"},{"id":75589419,"identity":"dc623a95-30ae-4568-a06f-58c889cb1514","added_by":"auto","created_at":"2025-02-06 06:55:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":190694,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e(a)\u003c/strong\u003e TEM micrographs of AgNPs and \u003cstrong\u003e(b)\u003c/strong\u003e Zeta potential of biologically synthesized AgNPs.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/bd4d58c9dfd4f3dd9ea7c9bb.png"},{"id":75588218,"identity":"55689bd6-a3c3-4953-a3d7-acf19a7b4a8f","added_by":"auto","created_at":"2025-02-06 06:47:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":4795758,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAFM 3D pictures of vicryl sutures. (a) \u003c/strong\u003econtrol uncoated vicryl suture, \u003cstrong\u003e(b)\u003c/strong\u003eCS-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e PVA-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003e AgNPs coated vicryl sutures.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/7d1a247ac67f76f04b98d6eb.png"},{"id":75588138,"identity":"5be9d820-84fd-4913-8fc4-1b3199e62690","added_by":"auto","created_at":"2025-02-06 06:47:04","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":4607674,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAFM 3D pictures of silk sutures. (a) \u003c/strong\u003econtrol uncoated silk suture, \u003cstrong\u003e(b)\u003c/strong\u003e CS-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e PVA-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003e AgNPs coated silk sutures.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/0c36a3f9be229216976256e9.png"},{"id":75588111,"identity":"63dadc6e-abe4-428c-bdc6-9a3c09111fa1","added_by":"auto","created_at":"2025-02-06 06:47:01","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":416219,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFE-SEM pictures of absorbable vicryl sutures. (a) \u003c/strong\u003econtrol uncoated vicryl suture, \u003cstrong\u003e(b)\u003c/strong\u003e PVA-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e CS-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003eAgNPs coated vicryl sutures.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/a4c6ad90843c9389c390b4bb.png"},{"id":75588112,"identity":"79735ef2-d3ef-426d-a8bf-5db1ea613f97","added_by":"auto","created_at":"2025-02-06 06:47:01","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":345491,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFE-SEM pictures of non-absorbable silk sutures. (a) \u003c/strong\u003econtrol uncoated silk suture, \u003cstrong\u003e(b)\u003c/strong\u003e PVA-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e CS-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003e AgNPs coated silk sutures.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/af9138b88207f02e931b5626.png"},{"id":75588116,"identity":"d4f83c04-cb5c-4798-b2ff-359ccdc0ffd6","added_by":"auto","created_at":"2025-02-06 06:47:01","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":229795,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEDX analysis with element percentiles of vicryl sutures. (a) \u003c/strong\u003econtrol uncoated vicryl suture, \u003cstrong\u003e(b)\u003c/strong\u003e PVA-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e CS-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003e AgNPs coated vicryl sutures.\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/c6557fd9015a800eb4b4038f.png"},{"id":75588144,"identity":"dedcbbb3-4273-48cf-8f30-984e6d2ef05b","added_by":"auto","created_at":"2025-02-06 06:47:04","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":227977,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eEDX analysis with element percentiles. (a) \u003c/strong\u003econtrol uncoated silk suture, \u003cstrong\u003e(b)\u003c/strong\u003e PVA-Ag coated, \u003cstrong\u003e(c)\u003c/strong\u003e CS-Ag coated and \u003cstrong\u003e(d)\u003c/strong\u003e AgNPs coated silk sutures.\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/0bcbb707d4f547c2dd8ebc85.png"},{"id":75588136,"identity":"ca43c963-6e81-4dac-ab6d-d9d48b540425","added_by":"auto","created_at":"2025-02-06 06:47:04","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":856731,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAntibacterial activity of coated and uncoated absorbable vicryl sutures at ascending concentrations of AgNPs, CS-Ag and PVA-Ag. a-h \u003c/strong\u003eMuller-Hinton agar plates cultured with Gram positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), \u003cem\u003eStreptococcus mutans \u003c/em\u003e(St1), and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) and Gram negative\u003cstrong\u003e \u003c/strong\u003e\u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1) bacterial isolates.\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/c273ffcef106bf8bbab42fcf.png"},{"id":75588132,"identity":"0ad53a30-cba1-44d6-9465-5a2b618dc4af","added_by":"auto","created_at":"2025-02-06 06:47:03","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":879785,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAntibacterial activity of coated and uncoated unabsorbable silk sutures at ascending concentrations of AgNPs, CS-Ag and PVA-Ag. a-h \u003c/strong\u003eMuller hinton agar plates cultured with Gram positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), \u003cem\u003eStreptococcus mutans \u003c/em\u003e(St1), and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) and Gram negative\u003cstrong\u003e \u003c/strong\u003e\u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1) bacterial isolates.\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/f7171cf9e3e147bc601c6f9d.png"},{"id":75588145,"identity":"3f0a96df-03e7-40dd-998e-72926af9ae05","added_by":"auto","created_at":"2025-02-06 06:47:04","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":41116,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical representation of antibacterial activity with inhibition zone. \u003cstrong\u003ea-c\u003c/strong\u003e (C1,C2, and C3) ascending concentrations of AgNPs, CS-Ag and PVA-Ag coated and uncoated vicryl sutures against Gram-positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), \u003cem\u003eStreptococcus mutans \u003c/em\u003e(St1), and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) and Gram-negative bacterial microorganisms \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1)\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/36a047a03be3e3ccc6e228f2.png"},{"id":75589417,"identity":"6ff2e563-e819-437f-90fa-595cfda02dd1","added_by":"auto","created_at":"2025-02-06 06:55:01","extension":"png","order_by":12,"title":"Figure 12","display":"","copyAsset":false,"role":"figure","size":75929,"visible":true,"origin":"","legend":"\u003cp\u003eGraphical representation of antibacterial activity with inhibition zone. \u003cstrong\u003ea-d\u003c/strong\u003e (C3, C4, C5 and C6) ascending concentrations of AgNPs, CS-Ag and PVA-Ag coated and uncoated vicryl sutures against Gram-positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), \u003cem\u003eStreptococcus mutans \u003c/em\u003e(St1), and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) and Gram-negative bacterial microorganisms \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1)\u003c/p\u003e","description":"","filename":"12.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/3daf0ea7f9bd0ad57446b106.png"},{"id":75588114,"identity":"9654563c-edeb-4767-9981-84719b4b25a3","added_by":"auto","created_at":"2025-02-06 06:47:01","extension":"png","order_by":13,"title":"Figure 13","display":"","copyAsset":false,"role":"figure","size":77354,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAntibiofilm activity of the uncoated and the coated sutures. a,b \u003c/strong\u003evicryl sutures,\u003cstrong\u003e c,d \u003c/strong\u003esilk sutures against (A1) and (P1). \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1) biofilm forming bacteria.\u003c/p\u003e","description":"","filename":"13.png","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/3e2dd0998984318435614572.png"},{"id":86178947,"identity":"e6891acf-1c74-4963-9250-6e6ba951098e","added_by":"auto","created_at":"2025-07-07 16:12:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":13283360,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5945870/v1/3420aab5-cb02-4fa6-a3a1-d9db64e8c9d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Coated Surgical Sutures: Nanoparticles and nanocomposite as coating materials for absorbable and nonabsorbable wound closure devices","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSurgical sutures are among the most important surgical devices used for wound closure. This type of filament-shaped device is one of the oldest and most common surgical device and cannot be outdated by modern technology in the medical field\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. However, it can be augmented with other properties to increase its efficiency and limit its drawbacks. The main function of sutures is closure of wounds and incision sites, and they can be classified according to their absorbability and biodegradability. They are made of dissimilar materials with variable absorbability ranges such as silk, nylon, cut gut and vicryl sutures\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. One of the major suture complications is the postsurgical infection (PSI) or site surgical infection (SSI) because bacterial growth and biofilm formation cause postoperative tissue inflammation surrounding the surgical site\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Sutures serve as a niche for bacterial attachment, proliferation and eventually biofilm formation. This major drawback significantly increases the infection risk by 10000 times. SSI increases mortality rates and is considered the most common hospital acquired infection. Furthermore, it strongly impacts the number of days of hospitalization and increases the cost of medical services per patient\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In 2011, the WHO reported that SSI was estimated to affect more than 20% of patients as postsurgical complication, increasing the use of systemic and localized antibiotics, which are associated with rouge and drug-resistant bacteria\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. This leads to a vicious cycle of repeated drug-resistant infections and the extreme use of antibiotics. Surgical sutures can be sterilized by autoclaving or chemical disinfection, nevertheless, these actions cannot guarantee the prevention of microbial attachment and growth once the sutures are used at surgical sites\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Bacterial growth and biofilm formation are complex processes at surgical sites. Both processes start with bacterial adhesion to suture materials after the implantation procedure and, consequently, proliferation and infection. Therefore, recent studies have focused on the initial prevention of this adhesion step and hence preventing the formation of biofilms with virulent and multi- drug resistant (MDR) bacteria\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Recently, coating surgical sutures with antibiotics has been adopted to add antimicrobial activity to sutures by limiting their susceptibility to bacterial growth and lowering surgical site complications. Multiple sutures have been improved by different antibiotics such as ciprofloxacin, levofloxacin hydrochloride, octenidine and chlorhexidine to reduce bacterial growth. However, this step faces the emergence and spread of MDR bacteria, causing an abbreviated period of bacterial inhibition and increasing the risk of wound healing and inflammatory reactions\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Therefore, the demand for an effective alternative was proposed. Currently, the direct delivery of antimicrobial products from sutures to scared tissue is used and targeted by many studies. Nanoparticle (NP) and nanocomposite (NC) coatings are the most developed alternatives to tackle microbial growth associated with surgical sites\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Coating surgical sutures has been reported as an effective strategy to increase their ability to fight microbial growth and prevent the formation of biofilms. Various physical, chemical, and biological pathways can be used to synthesize NPs. Biologically synthesized NPs can be achieved via the use of bacterial isolates as bio factories for the synthesis of stabilized NPs, where the bacterial cell structure provides an effective metabolic pathway for the bio-formation of NPs with well-defined shapes, high reactivity, and water solubility properties \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. These findings suggested that biologically synthesized NPs are the favored choice for many biomedical applications\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Silver nanoparticles (AgNPs) are among the most promising antimicrobial agents with a wide range of applications, such as in wound and burn healing, as well as in bone and dental implants\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. These nanoparticles can be bound to polymers that form NCs with antimicrobial properties. Polyvinyl alcohol (PVA) and chitosan (CS) have been integrated into many applications because they are biodegradable and biocompatible. PVA is FDA approved for use in the food industry and medical applications without side effects. Furthermore, CS is a natural polymer that can be hydrolyzed by a human enzymatic system into harmless products. Both PVA and CS can be used as biological scaffolds for nanoparticles, leading to a wider scope of applications\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In our study, biologically synthesized AgNPs were used, and the sol-gel coating method was employed to coat nonabsorbable silk and absorbable vicryl surgical sutures. Coated sutures were evaluated for their antimicrobial and antibiofilm activities against various bacterial isolates.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eBiosynthesis of silver nanoparticles and silver nanocomposites\u003c/h2\u003e \u003cp\u003eA schematic diagram of experimental setup is shown on Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Starting with AgNPs synthesis, which was achieved via the use of \u003cem\u003eEnterobacter cloacae\u003c/em\u003e Ism 26 (KP988024). Briefly, a bacterial culture was inoculated in 100 mL of nutrient broth medium, incubated at 35\u0026deg;C for 24 h, and then centrifuged for 15 min. AgNO\u003csub\u003e3\u003c/sub\u003e (1 mM) was mixed with the supernatant bacterial cell lysate and incubated at 35\u0026deg;C for 24 h. Lyophilized AgNPs were obtained via an Edwards model RV5 (England). These biologically synthesized NPs were used at different concentrations (W/V%) (0.1% (C1), 0.2% (C2), 0.3% (C3), 0.4%(C4), 0.5%(C5) and 0.6% (C6)) in further experiments. The synthesized AgNPs were mixed with PVA or CS separately to form silver nanocomposites. Briefly, 2 g of PVA (Alpha Cheimeka, India) was added to 20 ml of deionized water and magnetically stirred on a hot plate at 90\u0026deg;C for 3 h. Then, different concentrations of the biosynthesized AgNPs were added and stirred for another 4 h (from C1- C6) (w/v)). CS (0.4 g) was added to 20 ml of acetic acid (1%) and magnetically stirred for 1 h at 60\u0026deg;C; then, (from C1- C6) (w/v) AgNPs were added, and the mixture was further stirred for 2 h. These nanocomposite solutions were used for further experiments. Pure PVA and CS solutions were used as controls\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSol-gel coating of AgNPs and silver nanocomposites on surgical sutures\u003c/h3\u003e\n\u003cp\u003eVicryl (PGA-absorbable braided 4\u0026thinsp;\u0026minus;\u0026thinsp;0, Assucryl sutures, Switzerland) and silk (nonabsorbable braided 3\u0026thinsp;\u0026minus;\u0026thinsp;0, Assut medical sutures, Switzerland) sutures were immersed for 24 hrs at different AgNPs concentrations (C1- C3) (AgNPs, PVA-Ag, CS-Ag) for vicryl and (C1- C6) (AgNPs, PVA-Ag, CS-Ag) for silk. Uncoated sutures and sutures coated with pure solutions of PVA and CS were used as control. After 24 hrs, all the samples were grasped with sterilized tweezers and left to air dry in a laminar flow hood overnight. Finally, the coated wires were placed in an oven at 40\u0026deg;C for 10 min as a final step before use in further experiments. All the procedure steps were conducted under laminar flow, and all the samples were separated and sealed in sterilized Eppendorf tubes until the next experiments were performed \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eCharacterization of silver nanoparticles and coated sutures\u003c/h3\u003e\n\u003cp\u003eBiologically synthesized AgNPs were characterized via UV-Vis spectrometry to detect specific peaks (400\u0026ndash;450 nm) dynamic light scattering (DLS) and the zeta potential to determine the particle size and surface charge using a PSS-NICOMP particle sizer 380ZLS (Malvern Instruments Ltd.). Accurate nanoparticle shape and size in nm were identified via transmission electron microscopy \u003cb\u003e(\u003c/b\u003eTEM) (JOEL JEM-1010) at 80 kV at the Regional Centre for Mycology and Biotechnology (RCMB) of Al-Azhar University\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The surface topography and roughness of the uncoated and coated vicryl and silk sutures were determined via atomic force microscopy (AFM) (NanoSurf C3000, Gr\u0026auml;ubernstrasse, Liestal, Switzerland) operating in phase contrast mode. AFM provides 3D images with measurements of surface roughness, and irregularity in defined measured areas. The average thickness, roughness (Ra), and maximum roughness depth (Rq) were calculated for uncoated and coated sutures using image processing and data analysis software supplied with the AFM\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Furthermore, coated, and uncoated sutures were examined by field emission scanning electron microscopy with energy dispersive X-ray spectroscopy (FE-SEM/EDX) (QUANTA, FEG 250, Thermo Scientific) operating at an accelerating voltage of 30 kV to visualize the surface changes and detect the extent of the coating and its efficacy on the suture surface for all the tested coating materials vs. the uncoated control suture samples. EDX analysis was employed to calculate and identify the composition and elemental analysis of each sample surface. The suture samples were mounted on metallic copper stubs and fixed with carbon conductive tape at a standard tilt angle, and FE-SEM photomicrographs were taken from the surface at various magnifications\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Uncoated sutures served as controls throughout the experiments.\u003c/p\u003e\n\u003ch3\u003eAntibacterial activity\u003c/h3\u003e\n\u003cp\u003eThe antibacterial activity of all the coated and uncoated sutures was evaluated using an agar diffusion test according to the Clinical and Laboratory Standards Institute (CLSI). This test was performed against clinically relevant gram-positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), \u003cem\u003eStreptococcus mutans\u003c/em\u003e (St1), and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) and the gram-negative bacterial microorganisms \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1). The samples were placed on Muller-Hinton agar (MHA) plates inoculated with 10\u003csup\u003e6\u003c/sup\u003e CFU/ml bacterial cultures and then silk and vicryl sutures were placed on each plate (uncoated control, PVA-coated, CS-coated, AgNPs-coated, PVA-Ag coated, and CS-Ag coated). Finally, the inoculated plates were incubated at 37\u0026deg;C for 24 h and the diameter of the inhibition zone (mm) was measured; the results are reported as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eAntibiofilm activity\u003c/h3\u003e\n\u003cp\u003eCoated and uncoated silk and vicryl sutures were assessed for their ability to inhibit biofilm formation \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1) were used for this test. Using 20 ml of tryptic soy broth (TSB) (Merck, Germany) as culture media supplemented with 1% glucose, these biofilm forming bacteria were grown at 37\u0026deg;C for 24 h. Using a 96-well microtiter plate, 200 \u0026micro;l of each diluted bacterium (1:100) was inoculated into the wells that were previously supplied with coated and uncoated sutures. Microtiter plates were incubated at 37\u0026deg;C for 24 h. Then, each well was washed with phosphate buffered saline (pH 7.2) and dried for 30 min. The next step was the addition of crystal violet (CV) solution (0.1% w/v), after which the plates were washed and dried. Finally, 100 \u0026micro;l of ethanol (96%) was added to each well to extract the stained bound biofilm, and the CV absorbance optical density (OD) was measured and graphed at 490 nm with a microplate Reader (ELx808\u0026trade; Absorbance, Biotek, USA). Biofilm inhibition can be measured, and the percentage of inhibition was calculated using the following equation:\u003c/p\u003e \u003cp\u003e% inhibition\u0026thinsp;=\u0026thinsp;1\u0026ndash; (OD of coated sutures / OD of negative control) x 100\u003c/p\u003e \u003cp\u003eWhere, the OD of the coated sutures is the optical density of the sample.\u003c/p\u003e \u003cp\u003eThe OD of the negative control was the control for biofilm-forming bacteria.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuantification of released AgNPs from coated sutures\u003c/h2\u003e \u003cp\u003eThe amount of AgNPs released from the coated sutures was determined via Atomic Absorption Spectrometry (AAS) (Perkin Elmer 3100) after storage in phosphate-buffered saline for 14 days. The coated sutures were digested in nitric acid, and the concentration of AgNPs released was quantified.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe SPSS standard software package was used for data analysis. One-way analysis of variance (ANOVA) with Tukey\u0026rsquo;s post- hoc test was used to compare the effects between groups (n\u0026thinsp;=\u0026thinsp;5). The data are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SDs). The level of significant difference was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCharacterization of the nanoparticles and coated sutures\u003c/h2\u003e \u003cp\u003eAgNPs synthesized from \u003cem\u003eEnterobacter cloacae\u003c/em\u003e Ism 26 (KP988024) were characterized, and their morphology was detected. The TEM micrographs in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed rounded to spherical shaped nanoparticle sizes ranging from 33 to 14 nm, with an average size of 15 nm. The biologically synthesized AgNPs were negatively charged with a zeta potential of -34 mV as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Using the sol-gel coating technique, silk and vicryl sutures were immersed in various concentrations of AgNPs and nanocomposites.\u003c/p\u003e \u003cp\u003eAFM was performed for the coated and uncoated sutures via different fitting techniques to model the coating data and results. 3D image pseudocolored graphs are shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003e and \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e4\u003c/span\u003e, which reveal that the thickness and surface roughness change according to the different coating materials. The variability in thickness varied from silk to vicryl sutures and from one coating material to another. For the vicryl sutures, all the coating layers varied in thickness, with average thickness of 19.7, 25.7, and 42.1 nm, for the CS-Ag, PVA-Ag, and AgNPs samples, respectively. There was no major difference between the different coating layers on the vicryl sutures. However, by measuring the average Ra values, the data revealed a significant decrease in roughness, where uncoated vicryl sutures had an Ra value of 12.6 nm, and coated sutures had Ra values of 4.71, 7.09 and 2.80 nm for CS-Ag, PVA-Ag and AgNPs, respectively. Furthermore, the Rq values significantly decreased, where uncoated vicryl sutures had an Rq value of 14.13 nm, and coated sutures had much lower values of 5.37, 8.11 and 3.67 nm for CS-Ag, PVA-Ag and AgNPs, respectively. These tests and results were also performed and recorded on silk sutures. The thickness of the coating layers varied widely on average at 27.3, 43.4 and 600 nm for CS-Ag, PVA-Ag, and AgNPs, respectively. The type of coating material used on the silk sutures influenced the results. By measuring the average Ra values, the data were also highly influenced by the coating material type, where the control uncoated silk sutures had an Ra value of 2.3 nm, and the CS-Ag coating had an average value of 1.87 nm. However, the PVA-Ag coating increased the Ra value to 5.7 nm, whereas the AgNPs coating significantly increased the Ra value to 124.03 nm. The Rq values were also recorded with 3.01 nm for the uncoated silk sutures, a slightly lower value for CS-Ag at 2.20 nm and an increased value for the PVA-Ag coating. The AgNPs coating showed a remarkably high Rq value at 146.7 nm.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eField emission scanning electron microscopy (FE-SEM)/ energy dispersive x-ray spectroscopy (EDX)\u003c/h2\u003e \u003cp\u003eThe FE-SEM/EDX micrographs of the uncoated and coated sutures exposed the surface changes when the surfaces were coated with PVA-Ag, CS-Ag or AgNPs. These images confirmed the coverage of the coating layer on the surface of the silk and vicryl sutures as shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e6\u003c/span\u003e. By comparing uncoated silk and vicryl sutures with coated ones, the impact of coating with nanoparticles and nanocomposites was photographed, and all the coated sutures showed complete coverage of the material used on the suture surface by bright spots imbedded within the braided structure of the sutures. EDX analysis was used to examine the elemental composition of the coated sutures, which displayed the presence of major elements such as carbon (C), nitrogen (N) and oxygen (O), which are the main components of silk and vicryl sutures in addition to CS and PVA as presented in Figs.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Fig11\" class=\"InternalRef\"\u003e8\u003c/span\u003e. Furthermore, the elemental presence of silver (Ag) was evident in all the coated sutures confirming the presence and attachment of silver ions on the surface of the sutures. Additionally, the presence of Ag was limited by the use of PVA-Ag coated silk sutures and was much greater with the use of vicryl-coated sutures. However, its presence was more significant with the CS-Ag coated silk sutures that showed the highest number of bright spots indicating the presence and attachment of AgNPs and much lower with the vicryl-coated ones. For the AgNPs coated for both types of sutures, the amount of Ag was high.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eAntibacterial activity\u003c/h2\u003e \u003cp\u003eThe antibacterial activities of the coated and uncoated silk and vicryl sutures were evaluated at different concentrations, as shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig12\" class=\"InternalRef\"\u003e9\u003c/span\u003e and \u003cspan refid=\"Fig13\" class=\"InternalRef\"\u003e10\u003c/span\u003e. The antimicrobial effect of vicryl-coated sutures at lower concentrations was more significant than that of silk coated sutures, where at lower concentrations of AgNPs, vicryl-coated sutures have caused a wider range of inhibition zones against all tested gram positive and gram-negative bacteria. With respect to vicryl sutures, the uncoated sutures and PVA coated sutures showed no antibacterial effects at all concentrations. However, the AgNPs and PVA-Ag coated sutures showed antimicrobial activity at C3 only, as lower concentrations did not inhibit any of the bacteria tested. However, the CS-coated sutures significantly inhibited all bacterial isolates, and the CS-Ag coated sutures exhibited significant antimicrobial activity that was directly proportional to the AgNPs concentration. As shown in Figs.\u0026nbsp;\u003cspan refid=\"Fig14\" class=\"InternalRef\"\u003e11\u003c/span\u003e and \u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e12\u003c/span\u003e, the following inhibition zones were recorded: gram positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1), 25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70 mm; \u003cem\u003eStreptococcus mutans\u003c/em\u003e (St1), 17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30 mm; and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1), 27.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16 mm; and gram negative bacterial isolates \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1), 17.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89 mm; \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2), 17.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44 mm; and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1), 29.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10 mm. Silk sutures, both coated and uncoated, showed no antimicrobial activity at C1 or C2 with zero inhibition zones. However, as the AgNPs and nanocomposites concentrations increased, antimicrobial activity was observed. At C3, the number of bacterial species affected by the concentration increase was noteworthy. The most significant concentrations for the coated silk sutures were C5 and C6, and the inhibition effect reached a steady value with intersecting inhibition zones on the MHA plates. CS-Ag coated silk at C6 showed the most significant antimicrobial activity against all the gram-positive \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (S1) 25.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9 mm; \u003cem\u003eStreptococcus mutans\u003c/em\u003e (St1) 10.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1 mm; and \u003cem\u003eEnterococcus faecalis\u003c/em\u003e (E1) 20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 mm; and the gram-negative bacterial isolates \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1) 15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 mm; \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A2) 28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8 mm, and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1) 20 mm in size.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAntibiofilm activity\u003c/h2\u003e \u003cp\u003eCoated and uncoated silk and vicryl sutures were assessed for their antibiofilm activity against 2 of the most common biofilms forming bacterial isolates, \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (A1 and P1), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig16\" class=\"InternalRef\"\u003e13\u003c/span\u003e. The results showed that the PVA coated vicryl or silk sutures had the highest optical density, even greater than that of the uncoated silk or vicryl sutures, and the lowest biofilm inhibition among all the tested sutures. The coated groups, CS, CS-Ag, PVA-Ag and AgNPs, of silk and vicryl sutures presented a low optical density, indicating a high percentage of biofilm inhibition. The most significant inhibition was observed at C3 against \u003cem\u003eAcinetobacter baumannii\u003c/em\u003e (A1) and \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e (P1), with the use of CS-Ag coated vicryl sutures causing 89.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1% and 78.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.4%, respectively. The silk coated sutures needed a much higher concentration (C6) of AgNPs and nanocomposites to cause biofilm inhibition (86.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2% and 72.9\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3%, respectively) and optical density like those of the vicryl coated sutures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eRelease of silver ions from coated sutures\u003c/h2\u003e \u003cp\u003eThe release of Ag from each coated silk and vicryl sutures was calculated after 7 and 14 days. The AAS results showed that the Ag ions released were affected by type of suture and the coating material. As for the silk coated samples, after 7 days they showed the highest amount of Ag ions released with no significant change from that released after 14 days. Amount of Ag ions released ranged from 0.123 to 0.75 ppm for all silk coated sutures and from 0.03 to 0.93 ppm for all vicryl coated suture, along the 14 days. However, the PVA-Ag coated samples, either vicryl or silk sutures showed the highest amount of Ag ions released reaching 0.75 and 0.93 ppm, respectively.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eBiogenically synthesized AgNPs were perused in this study. The microorganism, \u003cem\u003eEnterobacter cloacae\u003c/em\u003e Ism 26 (KP988024), mediates the nucleation and growth of AgNPs\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. This pathway provides a spherical controlled shape, low aggregation rates, high homogeneity with a low polydispersity index (PI), highly stable nanoparticles and negatively charged nanoparticles that are used in addition to the nanocomposite as a coating layer on absorbable vicryl and nonabsorbable silk sutures. These sutures have been used for wound closure in oral and maxillofacial area such as after tooth extraction, buccal and/or lingual flaps, and flap closure in edentulous ridge. The use of nanoparticles has been reported in other studies \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, which have used various types of sutures to increase the effectiveness of nanomaterials coating and their impact on the future of one of the most ancient wound closure devices. In our study, we demonstrated the ability of vicryl and silk sutures to function and coat them with AgNPs, CS-Ag or PVA-Ag. The AFM results confirmed that coating a surgical suture can strongly influence surface roughness, causing a significant decrease in surface roughness, which explains the ability of the coated sutures to resist bacterial colonization and their significant efficacy against the tested bacterial isolates. Here, we can see that the antimicrobial results were complementary and confirmatory to the AFM results. Whereas the surface roughness decreased, bacterial accessibility to the suture surface decreased, which was, reflected by an increase in the bacterial inhibition zone and a decline in biofilm formation. These findings indicate the direct proportionality between surface roughness and bacterial attachment ability. These results can explain the extremely high bacterial optical density observed on uncoated silk and vicryl sutures and show that because a barrier can act as an insulator from bacterial attachment, it needs to be augmented with antimicrobial capabilities. This was confirmed by observing the state of PVA-coated sutures which acted as niches for bacterial colonization and did not cause any form of bacterial inhibition; in contrast, they act as attractive agents that amplify infection and colonization. Similar results were recorded in previous studies\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The presence of encapsulated nanomaterial and nanoparticles that function as antimicrobial agents, effectively attached to surgical devices, has significantly improved the ability of these devices to resist bacterial attachment and can be used as a superior choice to overcome current multidrug-resistant bacterial infections that infect foreign medical devices used on wounds\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFE-SEM/EDX of the PVA-Ag coated vicryl or silk sutures displayed a thick layer of coating that smoothed the surface of the sutures, but this alteration in surface morphology was not attributed to more AgNPs on the suture surface or higher antimicrobial activity, indicating the possibility of high affinity of PVA for sutures without significant properties, as the presence of this type of coating has led to more bacterial attachment and significantly decreased suture antibiofilm and antibacterial activities. On the contrary, the CS-Ag coated silk sutures exhibited a much thicker layer of coating with significant impact on bacterial growth and attachment, leading to significant results. This thin coating layer acted as a barrier and gave the AgNPs access to the bacterial cells in the surrounding environment to eliminate them and cause the greatest inhibition zones and biofilm inhibition. As a coating layer, only the AgNPs produced bright spots on the suture surfaces of both the silk and the vicryl sutures, as indicated by the antibacterial activity, which was significantly enhanced upon the addition of CS. Similar results were reported in previous studies\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The accessibility of AgNPs is highly influenced by their scaffold. Compared with nanoparticles alone, the ability of CS and PVA to carry AgNPs increased the inhibition zone and antibiofilm effectiveness. Furthermore, the antimicrobial activity of CS alone cannot be forgotten and has been multiplied by the addition of AgNPs, resulting in the highest rates of bacterial and biofilm inhibition\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Therefore, augmenting nanoparticles is an essential step in our research, as implementing lower concentrations of nanomaterials in addition to an effective carrier can channel these particles to their designated target. The Addition of this thin layer of coating on the suture surface has positively impacted the fight against MDR bacteria and SSI. Spherical-shaped nanoparticles have significantly greater antimicrobial effects on various bacterial species. The release of silver ions from both sutures has impacted the antimicrobial and antibiofilm activity but these effects were augmented upon the addition of CS, which has retained and sustained the coated sutures abilities. AgNPs have broad-spectrum antibacterial activity against gram positive and gram-negative bacteria, and their incorporation into medical devices can lead to increased antimicrobial and antibiofilm activities. The nanostructured silver has a high surface-to-volume ratio, leading to high efficacy in anchoring to the microorganism\u0026rsquo;s cell structure and highly penetrating the bacterial cell wall, forming free radicals, damaging DNA, causing structural changes and finally causing bacterial cell death\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. AgNPs can release Ag ions from silver clusters, and this continuous release ensures the durability of their antimicrobial activity. They are highly accessible to cells because of their nanosize range; therefore, their antimicrobial activity is uniquely high\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that no funds, grants, or other support was received during the preparation of this manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and affiliations\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiology Department, Faculty of Dentistry, Misr International University, Cairo, Egypt\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOmnia Mohamed Abdallah and Heba Rafaat Shebl\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral and maxillofacial surgery Department, Faculty of Dentistry, Misr International University, Cairo, Egypt\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRehab Ahmed Soliman\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAll the authors contributed to the study conception and design. OMA wrote the first draft of the manuscript, and all the authors commented on previous versions of the manuscript. All the authors have read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi, Y. \u003cem\u003eet al.\u003c/em\u003e Advances, challenges, and prospects for surgical suture materials. \u003cem\u003eActa Biomater.\u003c/em\u003e \u003cstrong\u003e168\u003c/strong\u003e, 78\u0026ndash;112 (2023).\u003c/li\u003e\n\u003cli\u003eGuadarrama-Reyes, S. C., Scougall-Vilchis, R. J., Morales-Luckie, R. A., S\u0026aacute;nchez-Mendieta, V. \u0026amp; L\u0026oacute;pez-Casta\u0026ntilde;ares, R. Antimicrobial Effect of Silk and Catgut Suture Threads Coated with Biogenic Silver Nanoparticles. in \u003cem\u003eSilver Nanoparticles - Fabrication, Characterization and Applications\u003c/em\u003e (InTech, 2018). doi:10.5772/intechopen.75074.\u003c/li\u003e\n\u003cli\u003eEdmiston, C. E. \u003cem\u003eet al.\u003c/em\u003e Microbiology of explanted suture segments from infected and noninfected surgical patients. \u003cem\u003eJ. Clin. Microbiol.\u003c/em\u003e \u003cstrong\u003e51\u003c/strong\u003e, 417\u0026ndash;421 (2013).\u003c/li\u003e\n\u003cli\u003eSyukri, D. M., Nwabor, O. F., Singh, S. \u0026amp; Voravuthikunchai, S. P. Antibacterial functionalization of nylon monofilament surgical sutures through in situ deposition of biogenic silver nanoparticles. \u003cem\u003eSurf. Coatings Technol.\u003c/em\u003e \u003cstrong\u003e413\u003c/strong\u003e, 127090 (2021).\u003c/li\u003e\n\u003cli\u003eSampathi, S., Tiriya, P. K., Dodoala, S., Junnuthula, V. \u0026amp; Dyawanapelly, S. Development of Biocompatible Ciprofloxacin\u0026ndash;Gold Nanoparticle Coated Sutures for Surgical Site Infections. \u003cem\u003ePharmaceutics\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 1\u0026ndash;14 (2022).\u003c/li\u003e\n\u003cli\u003eObermeier, A. \u003cem\u003eet al.\u003c/em\u003e Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI). \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 1\u0026ndash;20 (2018).\u003c/li\u003e\n\u003cli\u003eSyukri, D. M. \u003cem\u003eet al.\u003c/em\u003e Antibacterial-coated silk surgical sutures by ex situ deposition of silver nanoparticles synthesized with Eucalyptus camaldulensis eradicates infections. \u003cem\u003eJ. Microbiol. Methods\u003c/em\u003e \u003cstrong\u003e174\u003c/strong\u003e, 105955 (2020).\u003c/li\u003e\n\u003cli\u003eDubas, S. T., Wacharanad, S. \u0026amp; Potiyaraj, P. Tunning of the antimicrobial activity of surgical sutures coated with silver nanoparticles. \u003cem\u003eColloids Surfaces A Physicochem. Eng. Asp.\u003c/em\u003e \u003cstrong\u003e380\u003c/strong\u003e, 25\u0026ndash;28 (2011).\u003c/li\u003e\n\u003cli\u003eAbdallah, O. M., Shebl, H. R., Abdelsalam, E. \u0026amp; Mehrez, S. I. The impact and safety of encapsulated nanomaterials as a new alternative against carbapenem resistant bacteria. a systematic review. \u003cem\u003eWorld J. Microbiol. Biotechnol.\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 1\u0026ndash;12 (2024).\u003c/li\u003e\n\u003cli\u003ePotluri Leela Ravishankar, Vandana Vijayan, Sunanda K Rao, Saravanan A Vadivelu, D. N. \u0026amp; Surya Teja1. In Vitro Antibacterial Efficacy of Sutures Coated With Aloe vera and Ciprofloxacin: A Comparative Evaluation. \u003cem\u003eJ. Pharm. Bioallied Sci.\u003c/em\u003e \u003cstrong\u003e11\u003c/strong\u003e, 164\u0026ndash;168 (2019).\u003c/li\u003e\n\u003cli\u003eArora, A., Aggarwal, G., Chander, J., Maman, P. \u0026amp; Nagpal, M. Drug eluting sutures: A recent update. \u003cem\u003eJ. Appl. Pharm. Sci.\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 111\u0026ndash;123 (2019).\u003c/li\u003e\n\u003cli\u003eEdis, Z., Bloukh, S. H., Sara, H. A. \u0026amp; Azelee, N. I. W. Antimicrobial Biomaterial on Sutures, Bandages and Face Masks with Potential for Infection Control. \u003cem\u003ePolymers (Basel).\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, (2022).\u003c/li\u003e\n\u003cli\u003eAbdallah, O. M., Sedky, Y. \u0026amp; Shebl, H. R. Comprehensive evaluation of the antibacterial and antibiofilm activities of NiTi orthodontic wires coated with silver nanoparticles and nanocomposites: an in vitro study. \u003cem\u003eBMC Oral Health\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 1345 (2024).\u003c/li\u003e\n\u003cli\u003eNoronha, V. T. \u003cem\u003eet al.\u003c/em\u003e Silver nanoparticles in dentistry. \u003cem\u003eDent. Mater.\u003c/em\u003e \u003cstrong\u003e33\u003c/strong\u003e, 1110\u0026ndash;1126 (2017).\u003c/li\u003e\n\u003cli\u003eAbdallah, O. M. Antibacterial , antibiofilm and cytotoxic activities of biogenic polyvinyl alcohol-silver and chitosan-silver nanocomposites. 1\u0026ndash;9 (2020).\u003c/li\u003e\n\u003cli\u003eMonroy Caltzonci, D. A. \u003cem\u003eet al.\u003c/em\u003e Antimicrobial and Cytotoxic Effect of Positively Charged Nanosilver-Coated Silk Sutures. \u003cem\u003eACS Omega\u003c/em\u003e (2024) doi:10.1021/acsomega.4c01257.\u003c/li\u003e\n\u003cli\u003eZhou, Y. L., Yang, Q. Q., Zhang, L. \u0026amp; Tang, J. B. Nanoparticle-coated sutures providing sustained growth factor delivery to improve the healing strength of injured tendons. \u003cem\u003eActa Biomater.\u003c/em\u003e \u003cstrong\u003e124\u003c/strong\u003e, 301\u0026ndash;314 (2021).\u003c/li\u003e\n\u003cli\u003eBlinov, A. V. \u003cem\u003eet al.\u003c/em\u003e Surface-Oxidized Polymer-Stabilized Silver Nanoparticles as a Covering Component of Suture Materials. \u003cem\u003eMicromachines\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, (2022).\u003c/li\u003e\n\u003cli\u003eDing, Y. Q. \u003cem\u003eet al.\u003c/em\u003e A reduced graphene oxide-coated conductive surgical silk suture targeting microresistance sensing changes for wound healing. \u003cem\u003eSci. China Technol. Sci.\u003c/em\u003e \u003cstrong\u003e67\u003c/strong\u003e, 3499\u0026ndash;3512 (2024).\u003c/li\u003e\n\u003cli\u003eErcan, U. K. \u003cem\u003eet al.\u003c/em\u003e Prevention of bacterial colonization on nonthermal atmospheric plasma treated surgical sutures for control and prevention of surgical site infections. \u003cem\u003ePLoS One\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 1\u0026ndash;24 (2018).\u003c/li\u003e\n\u003cli\u003eBaygar, T. \u003cem\u003eet al.\u003c/em\u003e Fabrication of a Biocompatible Nanoantimicrobial Suture for Rapid Wound Healing after Surgery. \u003cem\u003eACS Omega\u003c/em\u003e \u003cstrong\u003e9\u003c/strong\u003e, 22573\u0026ndash;22580 (2024).\u003c/li\u003e\n\u003cli\u003eGuadarrama-Reyes, S. C., Scougall-Vilchis, R. J., Morales-Luckie, R. A., S\u0026aacute;nchez-Mendieta, V. \u0026amp; L\u0026oacute;pez-Casta\u0026ntilde;ares, R. Antimicrobial Effect of Silk and Catgut Suture Threads Coated with Biogenic Silver Nanoparticles. \u003cem\u003eSilver Nanoparticles - Fabr. Charact. Appl.\u003c/em\u003e (2018) doi:10.5772/intechopen.75074.\u003c/li\u003e\n\u003cli\u003eYang, Y. \u003cem\u003eet al.\u003c/em\u003e Bacterial inhibition potential of quaternised chitosan-coated VICRYL absorbable suture: An in vitro and in vivo study. \u003cem\u003eJ. Orthop. Transl.\u003c/em\u003e \u003cstrong\u003e8\u003c/strong\u003e, 49\u0026ndash;61 (2017).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Coated Sutures, Silver nanoparticles, Nanocomposite, Atomic force microscopy, Field emission scanning electron microscopy, Antibacterial","lastPublishedDoi":"10.21203/rs.3.rs-5945870/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5945870/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUpgrading the surgical sutures, as the main wound closure device, is essential. The evolution of bacterial resistance and the plummeting of antibiotics have directed research toward augmented sutures. Nanotechnology has provided answers to these concerns. The use of bacterial isolates as bio-factory for synthesized silver nanoparticles (AgNPs) and silver nanocomposites via a one pot ex situ method provides environmentally friendly silver nanocomposites in addition to the use of chitosan and polyvinyl alcohol polymers as carriers. Transmission electron microscopy (TEM) and zeta potential analysis revealed spherical negatively charged AgNPs. These nanoparticles and nanocomposites were used as coatings for absorbable vicryl and nonabsorbable silk surgical sutures. Atomic force microscopy (AFM) 3D images of these coated sutures showed a significant decrease in surface roughness with improved surface topography, specifically with chitosan-silver (CS-Ag) vicryl coated sutures with effective attachment of the nanocomposite and nanoparticles thin film on the suture surface. Field emission scanning electron microscopy with energy dispersive x-ray spectroscopy (FE-SEM/EDX) analysis showed the significant presence of the thin film of coating materials on the surface of the sutures and the significant elemental presentation of Ag. Vicryl and silk coated CS-Ag sutures showed significant antibacterial and antibiofilm activities against both gram positive and gram negative bacterial isolates. AgNPs coated silk and vicryl sutures recorded the lowest amounts of Ag ions at 0.03\u0026ndash;0.45 ppm released after 14 days, while polyvinyl alcohol-silver (PVA-Ag) coated ones showed the highest rates at 0.75\u0026ndash;0.93 ppm.\u003c/p\u003e","manuscriptTitle":"Coated Surgical Sutures: Nanoparticles and nanocomposite as coating materials for absorbable and nonabsorbable wound closure devices","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-06 06:46:51","doi":"10.21203/rs.3.rs-5945870/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-03-14T01:51:51+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-13T15:49:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-02-28T07:51:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148558195337426700102817787130781421826","date":"2025-02-04T15:55:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44898221886613327641061121080177832356","date":"2025-02-04T14:24:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-02-04T14:23:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-02-04T14:06:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-02-04T12:52:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-02-04T08:41:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-02-02T13:02:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7c2f9fb0-52c6-4887-8289-4784948d4605","owner":[],"postedDate":"February 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":43874470,"name":"Biological sciences/Biological techniques"},{"id":43874471,"name":"Biological sciences/Biotechnology"},{"id":43874472,"name":"Biological sciences/Microbiology"},{"id":43874473,"name":"Physical sciences/Nanoscience and technology"}],"tags":[],"updatedAt":"2025-07-07T16:01:00+00:00","versionOfRecord":{"articleIdentity":"rs-5945870","link":"https://doi.org/10.1038/s41598-025-07558-6","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-07-01 15:57:15","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-02-06 06:46:51","video":"","vorDoi":"10.1038/s41598-025-07558-6","vorDoiUrl":"https://doi.org/10.1038/s41598-025-07558-6","workflowStages":[]},"version":"v1","identity":"rs-5945870","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5945870","identity":"rs-5945870","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}