Electrospun surgical meshes with bioactive coatings for preventing postoperative infections in hernia repair

Functionalization of hernia repair mesh materials with drug-releasing coatings enables local and controlled therapeutic delivery, offering promising, cutting-edge devices to prevent postoperative infection. In this study, we evaluated in vitro and in vivo two novel antibacterial coatings applied to polypropylene meshes used in surgical hernia repair. Carboxymethylcellulose/polyvinyl alcohol (CMC/PVA) microfibers combined with chlorhexidine (CHX) or rifampicin (RIF) were electrospun on both sides of the mesh, establishing 4 groups: uncoated control; CMC/PVA; CMC/PVA + CHX; CMC/PVA + RIF. In vitro, drug release (HPLC), antibacterial activity (Staphylococcus aureus), and cytotoxicity (rabbit fibroblasts) were assessed. In vivo, uncoated control and coated meshes were implanted in a preclinical rabbit model of hernia repair challenged with bacteria. After 14 days, antibacterial efficacy and biocompatibility were evaluated by macroscopic inspection, sonication, light/scanning electron microscopy, and RAM-11 macrophage immunolabeling. The CMC/PVA + RIF meshes exhibited sustained release, complete bacterial eradication, and favorable tissue integration, without cytotoxic effects or excessive inflammation. Conversely, CHX-loaded coatings showed limited antibacterial performance and persistent infection near suture anchorage zones. Electrospinning enabled uniform, biodegradable coatings without compromising host response. These findings support the clinical relevance of CMC/PVA + RIF coatings as an effective anti-infective strategy and highlight the translational potential of electrospinning for surgical mesh optimization.