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Bacterial biofilms on implanted suture material are a cause of surgical site infection
Sandeep Kathju1, Laura Nistico, Irene Tower
11 Department of Plastic Surgery, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania.
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.
Insights
Bacterial biofilms on sutures can cause persistent surgical site infections (SSIs). Complete removal of these foreign bodies and biofilms is necessary for infection resolution.
Area of Science:
- Microbiology
- Infectious Diseases
- Surgical Innovation
Background:
- Surgical site infections (SSIs) affect up to 5% of procedures, significantly increasing healthcare costs.
- Bacterial biofilms on foreign bodies are known infection contributors, yet their role on submerged sutures is understudied.
- Implanted sutures may act as a nidus for biofilm formation, leading to persistent infections.
Purpose of the Study:
- To investigate the role of bacterial biofilms on implanted sutures in causing refractory surgical site infections (SSIs).
- To examine explanted suture material for biofilm presence and identify causative pathogens.
- To establish the efficacy of foreign body removal in resolving persistent SSIs.
Main Methods:
- Analysis of 15 patients with refractory abdominal wall SSIs after open Roux-en-Y gastric bypass.
- Microscopic examination of explanted sutures using confocal laser-scanning microscopy (CLSM) and fluorescence in situ hybridization (FISH).
- Assessment of clinical outcomes following complete removal of suture material and associated biofilms.
Main Results:
- All explanted sutures showed a "slimy" matrix or granulation tissue.
- CLSM confirmed abundant biofilm on all examined sutures.
- FISH identified specific pathogens within the biofilms, and complete foreign body removal cured all SSIs.
Conclusions:
- Bacterial biofilms colonizing implanted sutures are a significant cause of persistent surgical site infections.
- Complete surgical removal of biofilm-laden sutures is essential for resolving these refractory infections.
- This highlights the importance of considering suture material as a potential biofilm reservoir in managing chronic SSIs.
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