Microbiology of Explanted Suture Segments from Infected and Noninfected Surgical Patients

Abstract

f Sutures under selective host/environmental factors can potentiate postoperative surgical site infection (SSI). The present investigation characterized microbial recovery and biofilm formation from explanted absorbable (AB) and nonabsorbable (NAB) sutures from infected and noninfected sites. AB and NAB sutures were harvested from noninfected (70.9%) and infected (29.1%) sites in 158 patients. At explantation, devices were sonicated and processed for qualitative/quantitative bacteriology; selective sutures were processed for scanning electron microscopy (SEM). Bacteria were recovered from 85 (53.8%) explanted sites; 39 sites were noninfected, and 46 were infected. Suture recovery ranged from 11.1 to 574.6 days postinsertion. A significant difference in mean microbial recovery between noninfected (1.2 isolates) and infected (2.7 isolates) devices (P < 0.05) was noted. Staphylococcus epidermidis, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Peptostreptococcus spp., Bacteroides fragilis, Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa, and Serratia spp. were recovered from infected devices, while commensal skin flora was recovered from noninfected devices. No significant difference in quantitative microbial recovery between infected monofilament and multifilament sutures was noted. Biofilm was present in 100% and 66.6% of infected and noninfected devices, respectively (P < 0.042). We conclude that both monofilament and braided sutures provide a hospitable surface for microbial adherence: (i) a significant difference in microbial recovery from infected and noninfected sutures was noted, (ii) infected sutures harbored a mixed flora, including multidrug-resistant health care-associated pathogens, and (iii) a significant difference in the presence or absence of a biofilm in infected versus noninfected explanted devices was noted. Further studies to document the benefit of focused risk reduction strategies to minimize suture contamination and biofilm formation postimplantation are warranted.

Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement

“…These findings are of some interest because they seem to confirm that braided sutures are less susceptible, with respect to monofilament, to be colonized by bacteria, [38] and that double-blinding technique is not superior to a true blinded assessor of complications.…”

Inhibition of Pseudomonas aeruginosa biofilm formation on wound dressings

“…Wound dressings and surgical sutures often become contaminated with bacterial cells that can form biofilms on the surface of the wound dressing or implant . These biofilms can serve as a nidus of infection leading to exacerbation of the wound and delayed healing.…”

“…Wound dressings can provide additional surface area for bacterial cell attachment and biofilm formation within chronic wounds . Various reports have documented the presence of bacterial biofilms on wound dressings and a variety of medical implants, including surgical sutures and wound dressings using scanning electron microscopy (SEM) . Contamination of wound dressings often necessitates their removal and leads to additional wound debridement, increasing patient discomfort and further delaying the healing process .…”

“…[9][10][11] Various reports have documented the presence of bacterial biofilms on wound dressings and a variety of medical implants, including surgical sutures and wound dressings using scanning electron microscopy (SEM). [12][13][14] Contamination of wound dressings often necessitates their removal and leads to additional wound debridement, increasing patient discomfort and further delaying the healing process. [15][16][17][18] There is a pressing clinical need for innovative approaches to prevent adherence of bacterial cells and formation of biofilms on the surfaces of implants, sutures, and wound dressings.…”

Biofilm Formation by Clinical Isolates and Its Relevance to Clinical Infections

“…Strict anaerobes were detected in 70 % of wounds, with biofi lms observed in 35 % by epifl uorescence microscopy after applying stains to localize bacteria relative to their secreted extracellular matrix. In a study of bacteria adherent to surgical sutures removed from 158 patients (46 infected and 112 non-infected), biofi lms were visualized by scanning electron microscopy (SEM) (Edmiston et al 2013 ). Biofi lms were present by SEM an all 15 sutures removed from infected sites, and also on 10 of 15 non-infected, culturepositive suture samples.…”