Advanced Therapeutic Strategy for Managing Surgical Site Infections with Natural Nanoemulsion-Antimicrobial Combination

Fatma Alshehri¹Nada Alharbi¹Abdelnaser Zaid²Amira H Eltrawy³Shereen Fawzy³Attia M Gabr⁴Sawsan A Zaitone⁴Majid Alhomrani⁵Abdulhakeem S. Alamri⁵Rasha Abdel Moati Mosbah⁶Rana Elshimy⁷Abdallah Tageldein Mansour⁸Mahmoud Mohammed Bendary^9*

• ¹Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
• ²Assiut University, Assiut, Asyut, Egypt
• ³University of Tabuk, Tabuk, Tabuk, Saudi Arabia
• ⁴Suez Canal University, Ismaïlia, Ismailia, Egypt
• ⁵Taif University, Ta'if, Saudi Arabia
• ⁶Zagazig University, Zagazig, Al Sharqia, Egypt
• ⁷alharm canidain university, 6 october, Egypt
• ⁸King Faisal University, Al-Ahsa, Eastern Province, Saudi Arabia
• ⁹Port Said University, Port Said, Egypt

Surgical site infections (SSIs) are a significant cause of morbidity and mortality, often complicated by multidrug-resistant (MDR) pathogens and biofilm formation. This study evaluates the potential of a natural nanoemulsion containing chitosan, lavender, and curcumin, in combination with antimicrobial drugs, for treating SSIs. A comprehensive approach combining phenotypic and genotypic analyses, along with in vitro and in vivo studies, was used to assess the efficacy and safety of the combination therapy. The most common SSI pathogens identified wereAcinetobacter baumannii, with 50% exhibiting MDR, biofilm formation, and multiple virulence factors. Chitosan nanoemulsion showed the lowest minimum inhibitory concentration (MIC) (300-500 µg/mL), although it exceeded the cytotoxicity safety threshold (200 µg/mL). However, it significantly enhanced the antimicrobial activity of amikacin, resensitizing resistant strains at safe concentrations. The combination therapy of amikacin and chitosan nanoemulsion demonstrated superior efficacy in reducing bacterial loads in both Gram-negative and Grampositive infections. In vivo studies showed near-complete bacterial clearance by day 12.Histopathological analysis revealed enhanced wound healing, reduced inflammation, and restored tissue function. The combination of amikacin and chitosan nanoemulsion presents a promising therapeutic strategy for managing SSIs caused by MDR pathogens, improving bacterial eradication and wound healing. This study highlights chitosan nanoemulsion as an adjuvant therapy to combat antimicrobial resistance, enhance antibiotic efficacy, and improve SSI treatment outcomes. Further clinical studies are needed to optimize its use in patient care.