RESUMEN
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.
Asunto(s)
Infecciones Bacterianas/microbiología , Biopelículas , Suturas/microbiología , Bacterias Aerobias/aislamiento & purificación , Bacterias Aerobias/ultraestructura , Bacterias Anaerobias/aislamiento & purificación , Bacterias Anaerobias/ultraestructura , Humanos , Complicaciones PosoperatoriasRESUMEN
This article is based on a second Hygienist Panel meeting held in London on 16-17 June 2010. The Panel discussed the current use of antimicrobials and care bundles in the prevention of surgical site infection; the need to comply with good antibiotic stewardship, to reduce the risk of antibiotic-resistant and emergent organisms; and the need to revisit the use of antiseptics. The discussion was driven by concerns of the use of triclosan, which had been raised by a publication from the Scientific Committee on Consumer Products of the Directorate General for Health and Consumers, European Commission. Uncertainties that excessive use of triclosan for preservation and in cosmetics could select naturally resistant environmental organisms or induce reduced triclosan-susceptibility or antibiotic resistance were considered. It was concluded that the uses of triclosan with demonstrable health benefits, as in some medical applications (such as antimicrobial sutures), need to be distinguished from those where there is no proven benefit, such as its use in certain consumer products. The addition of triclosan to a product must be substantiated in any claim of preventive or therapeutic health benefit. Triclosan is the most widely studied biocide and this same level of information should be available for other topically used antimicrobials, which are widely used in surgical practice and chronic wound care.
Asunto(s)
Antiinfecciosos Locales/farmacología , Materiales Biocompatibles Revestidos , Infección de la Herida Quirúrgica/prevención & control , Suturas , Triclosán/farmacología , HumanosRESUMEN
BACKGROUND: This study evaluated the efficacy of polydioxanone suture with and without triclosan against gram-positive and gram-negative bacteria in vitro and in vivo. METHODS: Polydioxanone suture with and without triclosan was tested against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. In vivo evaluations were conducted in guinea pigs and mice in which test and control sutures (3-4 cm long) were implanted subcutaneously in the dorsal-lateral regions (control on left, test on right, 3-5 cm apart) through a 20 gauge catheter. Each implantation site was then challenged directly through the catheter with 4 x 10(5) colony-forming units (CFU) of S. aureus (guinea pigs) or 7 x 10(6) CFU of E. coli (mice). At 48 h post-implantation, the control and test sutures were explanted, and adherent bacteria were counted. RESULTS: Polydioxanone suture with triclosan demonstrated activity against all test organisms in vitro. The antibacterial activity was maintained until the sutures dissolved after 17 to 23 days when tested against E. coli and S. aureus, respectively. Evaluation in animal models demonstrated a 99.9% reduction in S. aureus and a 90% reduction in E. coli relative to controls. CONCLUSION: Polydioxanone suture with triclosan had activity in vitro against S. aureus, MRSA, E. coli, S. epidermidis, MRSE, and K. pneumoniae that persisted for as long as three weeks. In animal models, polydioxanone suture with triclosan inhibited in vivo colonization by S. aureus and E. coli.
Asunto(s)
Antibacterianos/farmacología , Enterobacteriaceae/efectos de los fármacos , Polidioxanona/farmacología , Staphylococcus/efectos de los fármacos , Suturas/microbiología , Triclosán/farmacología , Animales , Femenino , Cobayas , Resistencia a la Meticilina , Ratones , Pruebas de Sensibilidad Microbiana , Staphylococcus/clasificación , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/prevención & control , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the potential of synthetic surgical meshes (Marlex((R)) mesh [C.R. Bard, Inc., Murray Hill, NJ]; MYCROMESH PLUS [W.L. Gore and Associates, Inc., Flagstaff, AZ]; GYNECARE GYNEMESH Nonabsorbable PROLENE* Soft Mesh [Ethicon, Somerville, NJ]; and naturally derived surgical mesh materials (DermMatrix) [Carbon Medical Technologies, St. Paul, MN] and SURGISIS [Cook Surgical, Spencer, IN]) to serve as a nidus for microbial attachment and growth, thus exacerbating surgical site infection. METHODS: Meshes were implanted subcutaneously in mice and inoculated with 10(4) colony-forming units (cfu) of Staphylococcus aureus. Mice were euthanized four days later, and the implants were removed, homogenized, and cultured using a standard agar pour plate method to determine the number of viable bacteria that could be recovered from each implant. RESULTS: The Marlex mesh and Gynecare Gynemesh PS were comparable and "neutral" to infection, the average number of bacteria recovered being 1.61 x 10(5) and 5.41 x 10(4) cfu, respectively. Mycromesh Plus, with its antibacterial coating, resulted in a reduction in the number of bacteria recovered, the average being 1.61 x 10(1) cfu. Naturally derived meshes were considered to potentiate infection on the basis of macroscopic observation of infection and significantly increased numbers of bacteria recovered from the implant: 1.84 x 10(8) cfu from DermMatrix and 3.17 x 10(7) cfu from Surgisis. CONCLUSION: The synthetic meshes did not potentiate infection in this model, whereas the naturally-derived materials did. As this preclinical model was able to detect differences between different implant materials, it may have utility in assessing the infection potentiation properties of newly developed materials.
Asunto(s)
Materiales Biocompatibles Revestidos/farmacología , Infecciones Estafilocócicas/prevención & control , Mallas Quirúrgicas/microbiología , Infección de la Herida Quirúrgica/prevención & control , Animales , Materiales Biocompatibles Revestidos/química , Recuento de Colonia Microbiana , Modelos Animales de Enfermedad , Femenino , Ratones , Staphylococcus aureus/crecimiento & desarrollo , Mallas Quirúrgicas/efectos adversosRESUMEN
BACKGROUND: This study evaluated the ability of poliglecaprone 25 suture with triclosan to inhibit bacterial colonization by Escherichia coli and Staphylococcus aureus in mouse and guinea pig models. METHODS: Test and control sutures (3-4 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 3-5 cm apart) in 10 female Hartley guinea pigs (300-400 g) and 10 Swiss Webster mice (20-35 g) via a 20-gauge catheter. The test material was poliglecaprone 25 suture with triclosan (2-0, undyed), and the control material was poliglecaprone 25 suture (2-0, undyed). In the guinea pig model, each implantation site was challenged directly with 4x10(5) colony-forming units (cfu) of S. aureus, whereas in the mouse model, each implantation site was challenged directly with 1.3x10(7) cfu of E. coli through an indwelling catheter. At 48 h post-implantation, the control and test sutures were explanted, and bacterial enumeration was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered in the study groups 48 h post-implantation. Poliglecaprone 25 suture with triclosan produced a 3.4-log reduction in S. aureus and a 2-log reduction in E. coli compared with standard poliglecaprone 25 suture without triclosan under the same challenge conditions. The difference between the study groups in the number of bacteria recovered was significant (p < 0.05). CONCLUSION: Poliglecaprone 25 suture with triclosan inhibited bacterial colonization of the suture compared with untreated suture after direct in vivo challenge with S. aureus and E. coli in animal models.
Asunto(s)
Antiinfecciosos Locales/farmacología , Adhesión Bacteriana/efectos de los fármacos , Dioxanos , Poliésteres , Infección de la Herida Quirúrgica/prevención & control , Suturas/microbiología , Triclosán/farmacología , Animales , Materiales Biocompatibles Revestidos , Recuento de Colonia Microbiana , Escherichia coli/efectos de los fármacos , Femenino , Cobayas , Ratones , Pruebas de Sensibilidad Microbiana/métodos , Staphylococcus aureus/efectos de los fármacosRESUMEN
BACKGROUND: This study evaluated the in vitro efficacy of poliglecaprone 25 suture with triclosan against gram-positive and gram-negative bacteria. METHODS: Poliglecaprone 25 sutures with and without triclosan were tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, methicillin-resistant Staphylococcus epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli by a zone of inhibition assay. The suture also was tested against Escherichia coli in a colonization assay in a dynamic model simulating in vivo conditions. An in vitro triclosan diffusion assay and a sustained efficacy assay were performed by concurrent high-performance liquid chromatography and zone of inhibition assay. To assess stability, antibacterial efficacy testing was performed on samples held more than five months at elevated temperature. RESULTS: Poliglecaprone 25 suture with triclosan demonstrated significant in vitro efficacy against a range of bacteria. The suture sustained in vitro efficacy for 11 days, corresponding to the in vitro triclosan diffusion profile. CONCLUSION: Triclosan reduced in vitro colonization of poliglecaprone 25 suture by several strains of bacteria compared with untreated control sutures.
Asunto(s)
Antiinfecciosos Locales/farmacología , Adhesión Bacteriana/efectos de los fármacos , Materiales Biocompatibles Revestidos , Dioxanos , Poliésteres , Suturas/microbiología , Triclosán/farmacología , Recuento de Colonia Microbiana , Enterobacteriaceae/efectos de los fármacos , Cocos Grampositivos/efectos de los fármacos , Técnicas In Vitro , Pruebas de Sensibilidad Microbiana/métodos , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
BACKGROUND: This study evaluated the ability of coated polyglactin 910 suture with triclosan (Coated VICRYL Plus Antibacterial) suture to inhibit the colonization of bacteria on the suture after direct in vivo inoculation challenge with Staphylococcus aureus utilizing a guinea pig model. METHODS: One control suture (4-5 cm) and one test suture (4-5 cm) were implanted subcutaneously in the dorsal-lateral regions (control on the left side, test on the right side, approximately 5 cm apart) in 16 female Hartley guinea pigs (300-400 g) via a 20-gauge catheter. Each implantation site was challenged directly with 2.1 x 10(4) colony forming units (cfu) of Staphylococcus aureus through the indwelling catheter. The test material was coated polyglactin 910 suture with triclosan (2-0, dyed), and the control material was coated polyglactin 910 suture (2-0, undyed). At 48 h, suture articles were explanted and a bacterial enumeration assay was performed. RESULTS: There was a significant difference (p < 0.05) in the number of bacteria recovered between the study groups at 48 h post-implantation. The mean recovery for test sutures was 559 cfu, and the mean recovery for control sutures was 16,831 cfu. Coated polyglactin 910 suture with triclosan provided a 30.5-fold (96.7%) reduction in the number of recovered bacteria compared to standard coated polyglactin 910 suture. CONCLUSIONS: This study demonstrates that coated polyglactin 910 suture with triclosan inhibits bacterial colonization of suture after direct in vivo challenge with S. aureus in a guinea pig model.
Asunto(s)
Poliglactina 910/farmacología , Staphylococcus aureus/crecimiento & desarrollo , Suturas/microbiología , Animales , Materiales Biocompatibles Revestidos , Recuento de Colonia Microbiana , Intervalos de Confianza , Modelos Animales de Enfermedad , Femenino , Cobayas , Incidencia , Ensayo de Materiales , Valores de Referencia , Medición de Riesgo , Sensibilidad y Especificidad , Infecciones Estafilocócicas , Técnicas de SuturaRESUMEN
BACKGROUND: The emergence of multi-drug resistant microorganisms presents a critical problem for patients undergoing surgery. Acidic pH, which is produced by oxidized regenerated cellulose (ORC), is a broad-spectrum physiological detriment to survival of microorganisms known to cause surgical infections. The purpose of this study was to examine the antimicrobial effect of ORC against antibiotic-resistant organisms. METHODS: ORC products were challenged with ATCC reference strains and clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE), vancomycin-resistant Enterococcus (VRE), penicillin-resistant Streptococcus pneumoniae (PRSP), and non-resistant ATCC strains of S. aureus and Pseudomonas aeruginosa. Samples of three ORC products (SURGICEL absorbable hemostat, SURGICEL Fibrillar absorbable hemostat, and SURGICEL NU-KNIT absorbable hemostat and identified, respectively, as ORC-R, ORC-F, and ORC-N for this study) were inoculated with challenge organisms in nutrient broth to produce a weight to volume ratio of 15 mg ORC/mL. Plate counts were performed at 0, 1, 6, and 24 h. RESULTS: Antimicrobial activity was seen with all three ORC products against the challenge organisms. Data indicate that antibiotic-resistant microorganisms remain susceptible to the antimicrobial activity of ORC. In testing with nine of 10 bacteria, including four antibiotic-resistant clinical isolates (VRE, MRSA, and PRSP) three-log or greater reductions were seen at 24-h exposure. One ATCC strain of VRE demonstrated some level of resistance to the acidic pH effect. ORC-N showed a three-log reduction with this organism, whereas the reductions with ORC-R and ORC-F were less than one log. CONCLUSION: Since low pH affects a relatively broad-spectrum of bacteria and does not act in a mechanism-specific manner, as do antibiotics, antibiotic-resistant strains of bacteria are unlikely to resist the ORC pH effect. Results of this in vitro assessment support the hypothesis that the antimicrobial activity of ORC is effective against antibiotic-resistant microorganisms.
Asunto(s)
Celulosa Oxidada/farmacología , Resistencia a Medicamentos , Enterococcus/efectos de los fármacos , Humanos , Concentración de Iones de Hidrógeno , Técnicas In Vitro , Resistencia a la Meticilina , Resistencia a las Penicilinas , Pseudomonas aeruginosa/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Streptococcus pneumoniae/efectos de los fármacos , Resistencia a la VancomicinaRESUMEN
BACKGROUND: In this study, coated polyglactin 910 suture with triclosan was evaluated for its ability to inhibit the growth of wild-type and methicillin-resistant Staphylococcus aureus and S. epidermidis using several in vitro models. METHODS: In the standard experimental procedure, sterile sutures were inoculated with bacteria, plated in semisolid culture media, incubated for 24 h, and examined for zones of inhibition surrounding the sutures. Sutures were pretreated by several methods prior to inoculation, these included: 24-h aqueous immersion, serial 7-day aqueous immersion, knotting, and passage through subcutaneous and fascial tissue. Sutures were also compared to determine if suture diameter had an effect on the zone of inhibition. RESULTS: Coated polyglactin 910 suture with triclosan inhibited growth of test organisms consistently over a range of suture diameters and treatment conditions. The antibacterial effect was robust and did not diminish when sutures were placed in an aqueous environment for up to 7 days. Knotted suture with triclosan inhibited bacterial colonization after replicate inoculation. The bacteria-free zone surrounding each knotted suture had a volume of 14.5 cm(3) for S. epidermidis and 17.8 cm(3) for S. aureus. Coated polyglactin 910 suture with triclosan continued to produce zones of inhibition after five and 10 passes through fascia and subcutaneous tissue. CONCLUSION: These data support the conclusion that coated polyglactin 910 suture with triclosan provides antimicrobial effect sufficient to prevent in vitro colonization by S. aureus and S. epidermidis.
Asunto(s)
Antiinfecciosos Locales/farmacología , Antiinfecciosos Locales/uso terapéutico , Bioensayo , Materiales Biocompatibles Revestidos/farmacología , Materiales Biocompatibles Revestidos/uso terapéutico , Inhibición de Contacto/efectos de los fármacos , Poliglactina 910/farmacología , Poliglactina 910/uso terapéutico , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus/efectos de los fármacos , Staphylococcus epidermidis/efectos de los fármacos , Triclosán/farmacología , Triclosán/uso terapéutico , Antiinfecciosos Locales/administración & dosificación , Recuento de Colonia Microbiana , Humanos , Técnicas In Vitro , Resistencia a la Meticilina , Staphylococcus aureus/crecimiento & desarrollo , Staphylococcus epidermidis/crecimiento & desarrollo , Factores de Tiempo , Triclosán/administración & dosificaciónRESUMEN
BACKGROUND: Several different techniques are used for wound closure. Cyanoacrylate tissue adhesives are less invasive and easy to apply, and the cosmetic results are comparable to or better than the conventional methods for wound repair. The purpose of this study is to demonstrate that Dermabond Topical Skin Adhesive, 2-octylcyanoacrylate (a registered trademark of Ethicon) is an effective barrier against the penetration of microorganisms in an in vitro model. MATERIALS AND METHODS: Octylcyanoacrylate adhesive was evaluated in vitro as a barrier to microbial penetration using a strike through test. Agar media containing pH sensitive dye was used. The dye changed color in the presence of acidic microbial metabolic products. Octylcyanoacrylate adhesive was applied to the agar surface to form uniformly thick films. A total of 300 single layered films and an additional 300 triple layered films were evaluated. A 10-microL aliquot of inoculum containing at least 1x10(3) cfu was applied to the surface of each film. Plates were incubated at 37 degrees C for 72 h and were observed for growth and color change every 24 h during the incubation period. RESULTS: A series of binomial calculations were performed, varying the level of effectiveness of the test and the level of statistical confidence. Of the 600 test articles evaluated, 598 retained their patency at the end of 72 h. One individual test film was invalidated due to extrinsic contamination. The data presented indicated that octylcyanoacrylate tissue adhesive provided a barrier to microbial penetration with 95% confidence of 99% efficacy for 72 h in this in vitro model. CONCLUSION: The results of these in vitro experiments supported the hypothesis that octylcyanoacrylate tissue adhesive is an effective barrier to microbial penetration by gram-positive and gram-negative motile and nonmotile species.