Engineering matrix-embedded dual-drug eluting biodegradable surgical sutures for prophylaxis against surgical site infections

Abstract

Despite advances in aseptic technique and conventional antimicrobial prophylaxis, surgical site infections (SSIs) remain a leading cause of postoperative morbidity, mortality, and healthcare costs globally. Traditional sutures merely approximate tissue and can harbour microorganisms that drive the emergence of multidrug-resistant pathogens. Thus, SSIs contribute significantly to the spread of antimicrobial resistance (AMR). To address this dual challenge, this study focuses on developing and characterize biodegradable, multi-drug-eluting sutures capable of localised delivery of two therapeutic agents to prevent infection and promote wound healing. Two clinically relevant therapeutic agents, levofloxacin (broad-spectrum antibiotic) and ibuprofen (an anti-inflammatory), were incorporated into biodegradable polycaprolactone (PCL) polymer. Placebo (F1), levofloxacin-only (F2), and dual-drug (F3) biodegradable sutures conforming to the USP 2–0 size specification were successfully fabricated using solvent-free hot-melt extrusion technology. Solid-state analyses (DSC and PXRD), as well as FTIR and Raman spectroscopy, confirmed that the drugs were amorphous and molecularly dispersed in the suture. In vitro drug release was diffusion-controlled and best fitted by the Korsmeyer–Peppas model. Mechanical properties remained suitable, with Young's modulus and elongation at break unaffected by drug loading, and tensile strength ranging from 88.3 ± 12.9 MPa (F1) to 69.5 ± 7.8 MPa (F3). This work demonstrates the feasibility of hot-melt extrusion as a solvent-free and green technique to produce sustained-release, multi-drug-eluting sutures with acceptable handling properties for clinical application.