Abstract
Background
Wound healing impairment is a serious problem in surgical disciplines which may be associated with chronic morbidity, increased cost and patient discomfort. Here we aimed to investigate the relevance of bacterial colonisation on suture material using polymerase chain reaction (PCR) to detect and taxonomically classify bacterial DNA in patients with and without wound healing problems after routine neurosurgical procedures.
Methods
Repeat surgery was performed in 25 patients with wound healing impairment and in 38 patients with well-healed wounds. To determine the presence of bacteria, a 16S rDNA-based PCR detection method was applied. Fragments of 500 bp were amplified using universal primers which target hypervariable regions within the bacterial 16S rRNA gene. Amplicons were separated from each other by single-strand conformation polymorphism (SSCP) analysis, and finally classified using Sanger sequencing.
Results
PCR/SSCP detected DNA of various bacteria species on suture material in 10/38 patients with well-healed wounds and in 12/25 patients with wound healing impairment including Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes and Escherichia coli. Microbiological cultures showed bacterial growth in almost all patients with wound healing impairment and positive results in PCR/SSCP (10/12), while this was the case in only one patient with a well-healed wound (1/10).
Conclusions
Colonisation of suture material with bacteria occurs in a relevant portion of patients with and without wound healing impairment after routine neurosurgical procedures. Suture material may provide a nidus for bacteria and subsequent biofilm formation. Most likely, however, such colonisation of sutures is not a general primer for subsequent wound infection.
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The main thrust of the article is to demonstrate the presence of bacterial contamination as revealed by PCR analysis in about a quarter of patients with well healed wounds undergoing repeat surgery for secondary reasons. The clinical import of this finding is not clear as wound infections beyond the mean of 10 months after primary surgery (the time between first and repeat surgery for healed wounds in this study) is quite rare. Unsurprisingly, in patients with wound healing problems PCR analysis revealed suture bacterial contamination in about half the cases. Why some patients with suture contamination go on to develop wound infections remains speculative.The authors discuss some technological means to make the suture material a less hospitable site for colonisation.
Zvi Harry Rappaport
Petah Tiqva, Israel
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Hong, B., Winkel, A., Ertl, P. et al. Bacterial colonisation of suture material after routine neurosurgical procedures: relevance for wound infection. Acta Neurochir 160, 497–503 (2018). https://doi.org/10.1007/s00701-017-3404-9
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DOI: https://doi.org/10.1007/s00701-017-3404-9