Bacterial Biofilms on Implanted Suture Material Are a Cause of Surgical Site Infection

Abstract

Background: Surgical site infection (SSI) has been estimated to occur in up to 5% of all procedures, accounting for up to 0.5% of all hospital costs. Bacterial biofilms residing on implanted foreign bodies have been implicated as contributing or causative factors in a wide variety of infectious scenarios, but little consideration has been given to the potential for implanted, submerged suture material to act as a host for biofilm and thus serve as a nidus of infection. Methods: We report a series of 15 patients who underwent open Roux-en-Y gastric bypass (with musculofascial closure with permanent, multifilament sutures) who developed longstanding and refractory SSIs in the abdominal wall. Explanted suture material at subsequent exploration was examined for biofilm with confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH). Results: All 15 patients at re-exploration were found to have gross evidence of a ''slimy'' matrix or dense reactive granulation tissue localized to the implanted sutures. Confocal laser-scanning microscopy revealed abundant biofilm present on all sutures examined; FISH was able to identify the presence of specific pathogens in the biofilm. Complete removal of the foreign bodies (and attendant biofilms) resulted in all cases in cure of the SSI. Conclusion: Bacterial biofilms on implanted suture material can manifest as persistent surgical site infections that require complete removal of the underlying foreign body substrata for resolution.

Inhibition of Pseudomonas aeruginosa biofilm formation on wound dressings

“…These biofilms can serve as a nidus of infection leading to exacerbation of the wound and delayed healing. While their development and persistence is multifactorial, it is clear that chronic nonhealing skin wounds are often infected with pathogenic biofilms that impact the healing process . The overall focus of our research team is to develop novel biomaterial‐based dressings, which can be applied to chronic nonhealing skin wounds, to prevent formation of or eliminate bacterial biofilms on the skin wound bed and aid healing.…”

“…While their development and persistence is multifactorial, it is clear that chronic nonhealing skin wounds are often infected with pathogenic biofilms that impact the healing process. 9,47 The overall focus of our research team is to develop novel biomaterial-based dressings, which can be applied to chronic nonhealing skin wounds, to prevent formation of or eliminate bacterial biofilms on the skin wound bed and aid healing. In this study, we documented that the essential amino acid tryptophan inhibits P. aeruginosa biofilms on a clinically relevant biological wound dressing.…”

Prevention and treatment ofStaphylococcus aureusbiofilms

“…One of the major causes of concern with implant infections is the early development of biofilms, with S. aureus commonly isolated as the cause. [76–78] Retention of implants, however, may result in failure to resolve these infections, requiring revision surgery with antibiotic treatment. Irrigation and/or pulsed lavage are other physical removal techniques that have been used extensively.…”

Innovative Modifications for Preventing Mesh Infections

“…This phenomenon has led scientists and surgeons to search for local innovative solutions so as to block mesh infection because usually the single effective intervention that can be applied is to remove the mesh in infected cases and to try to repair the defect without using prosthetic material [70][71][72][73][74][75].…”