In vitro comparison of efficacy of triclosan coated & uncoated sutures against the bacteria isolated from SSI at tertiary care hospital, Aurangabad

Abstract

Most common Health Care Associated Infections (HAI) are Urinary tract infection (UTI) -33%, Pneumonia -15%, Surgical Site Infections (SSI) -15%, Blood stream infections -13%, & other miscellaneous infections -24%. SSI is defined as infection at the surgical site that occurs within 30 days of the surgical procedure or within one year -if there is an implant or foreign body such as prosthetic heart valve or joint prosthesis. Wound infections are always multifactorial. Risk factors for SSI include co-morbidity, malnutrition, nicotine, suture and implanted foreign material. SSI increases morbidity & mortality in post surgical patients, & also increases hospital stay, it affects quality of life and increases financial burden to healthcare system. It may lead to major complications such as sepsis and death. Patient related risk factors are smoking, obesity and diabetes. Skin preparation with antiseptic and preoperative antibiotic prophylaxis for clean-contaminated and contaminated surgery have proved efficient for decreasing SSI. Sutures in contaminated tissues may enhance penetration of micro organisms in deeper tissues & biofilm formation and this may protect organisms from host defence mechanism. One of the risk factors is the foreign material which includes suture. Commonly isolated pathogens from SSI are Staphylococcus aureus, CONS, Enterococcus species, E.coli & resistant pathogens like MRSA & candida (due to widespread use of broad spectrum anti-microbial agents.) In this study we have compared in vitro efficacy of triclosan coated polyglactin 910 suture with non -coated sutures against common bacteria isolated from SSI. Materials and Methods: We have randomly selected the strains of MRSA, MRCONS, Staphylococcus hemolyticus, E. Coli, Klebsiella, & Acinetobacter species isolated from clinical samples of SSI. These isolates were tested against triclosan coated & non coated sutures which are commercially available. Similar length of (4cm) of sutures cut & tested for zone of inhibition on lawn culture made on Muller Hinton Agar (MHA) by using 0.5 McFarland standard of above strains by touching 4 to 5 colonies of each bacterium. It is incubated overnight at 37 0 C & examined for zone of inhibition. Results: zone of inhibition of coated & uncoated sutures has been measured & compared for each strain. Conclusion: In vitro, triclosan coated sutures showed good antibacterial activity than non coated sutures & hence triclosan coated sutures may help in reducing bacterial SSI rate and thus reduce cost & duration of hospital stay for the patient.