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Bacterial colonisation of suture material after routine neurosurgical procedures: relevance for wound infection

  • Original Article - Neurosurgical Anatomy
  • Published:
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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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References

  1. Akiyama H, Torigoe R, Arata J (1993) Interaction of Staphylococcus aureus cells and silk threads in vitro and in mouse skin. J Dermatol Sci 6:247–257

    Article  CAS  PubMed  Google Scholar 

  2. Bassam BJ, Caetano-Anolles G, Gresshoff PM (1991) Fast and sensitive silver staining of DNA in polyacrylamide gels. Anal Biochem 196:80–83

    Article  CAS  PubMed  Google Scholar 

  3. Benson DA, Cavanaugh M, Clark K, Karsch-Mizrachi I, Lipman DJ, Ostell J, Sayers EW (2013) GenBank. Nucleic Acids Res 41:D36–D42

    Article  CAS  PubMed  Google Scholar 

  4. Chu CC, Williams DF (1984) Effect of physical configuration and chemical structure of suture material on bacterial adherence. Am J Surg 147:197–204

    Article  CAS  PubMed  Google Scholar 

  5. Chu XM, Yu H, Sun XX, An Y, Li B, Li XB (2015) Identification of bacteriology and risk factor analysis of asymptomatic bacterial colonization in pacemaker replacement patients. PLoS One 10:e0119232

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cooper R, Percival SL (2010) Human skin and microflora. In: Percival SL, Cutting K (eds) Microbiology of wounds. CRC Press, London, UK, pp 58–82

    Google Scholar 

  7. Dhom J, Bloes DA, Peschel A, Hofmann UK (2017) Bacterial adhesion to suture material in a contaminated wound model: comparison of monofilament, braided, and barbed sutures. J Orthop Res 35:925–933

    Article  CAS  PubMed  Google Scholar 

  8. Donlan RM, Costerton JW (2002) Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev 15:167–193

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Edlich RF, Panek PH, Rodeheaver GT, Kurtz LD, Edgerton MT (1974) Surgical sutures and infection: a biomaterial evaluation. J Biomed Mater Res 8:115–126

    Article  CAS  PubMed  Google Scholar 

  10. Edmiston CE, Krepel CJ, Marks RM, Rossi PJ, Sanger J, Goldblatt M, Graham MB, Rothenburger S, Collier J, Seabrock GR (2013) Microbiology of explanted suture segments from infected and noninfected surgical patients. J Clin Microbiol 51:417–421

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Edmiston CE, McBAin AJ, Kieman M, Leaper DJ (2016) A narrative review of microbial biofilm in postoperative surgical site infections: clinical presentation and treatment. J Wound Care 25:693–702

    Article  CAS  PubMed  Google Scholar 

  12. Edmiston CE Jr, McBain AJ, Roberts C, Leaper D (2015) Clinical and microbiological aspects of biofilm-associated surgical site infection. Adv Exp Med Biol 830:47–67

    Article  PubMed  Google Scholar 

  13. Glage S, Paret S, Winkel A, Stiesch M, Bleich A, Krauss JK (2017) Schwabe K (2017) A new model for biofilm formation and inflammatory tissue reaction: intraoperative infection of a cranial implant with Staphylococcus aureus in rats. Acta Neurochir. https://doi.org/10.1007/s00701-017-3244-7

  14. Götz F (2002) Staphylococcus and biofilms. Mol Microbiol 43:1367–1378

    Article  PubMed  Google Scholar 

  15. Harnet JC, Le Guen E, Ball V, Tenenbaum H, Ogier J, Haikel Y, Vodouhê C (2009) Antibacterial protection of suture material by chlorhexidine-functionalized polyelectrolyte multilayer films. J Mater Sci Mater Med 20:185–193

    Article  CAS  PubMed  Google Scholar 

  16. Henry-Stanley MJ, Hess DJ, Barnes AM, Dunny GM, Wells CL (2010) Bacterial contamination of surgical suture resembles a biofilm. Surg Infect 11:433–439

    Article  Google Scholar 

  17. Heuer W, Elter C, Demling A, Neumann A, Suerbaum S, Hannig M, Heidenblut T, Bach FW, Stiesch-Scholz M (2007) Analysis of early biofilm formation on oral implants in man. J Oral Rehabil 34:377–382

    Article  CAS  PubMed  Google Scholar 

  18. Ismi O, Ozcan C, Vavisoğlu Y, Öztürk C, Tek SA, Görür K (2017) Transseptal suturing technique in septoplasty: impact on bacteremia and nosocomial colonization. Eur Arch Otorhinolaryngol 274:2189–2195

    Article  PubMed  Google Scholar 

  19. Kanayama M, Hashimoto T, Shigenobu K, Oha F, Iwata A, Tanaka M (2017) MRI-based decision making of implant removal in deep wound infection after instrumented lumbar fusion. Clin Spine Surg 30:E99–E103

    PubMed  Google Scholar 

  20. Kathju S, Nistico L, Hall-Stoodley L, Post JC, Ehrlich GD, Stoodley P (2009) Chronic surgical site infection due to suture-associated polymicrobial biofilm. Surg Infect 10:457–461

    Article  Google Scholar 

  21. Kathju S, Nistico L, Tower I, Lasko LA, Stoodley P (2014) Bacterial biofilms on implanted suture material are a cause of surgical site infection. Surg Infect 15:592–600

    Article  Google Scholar 

  22. Katz S, Izhar M, Mirelman D (1981) Bacterial adherence to surgical sutures: a possible factors in suture induce infection. Ann Surg 194:35–41

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Leknes KN, Selvig KA, Bøe OE, Wikesjö UME (2005) Tissue reactions to sutures in the presence and absence of anti-infective therapy. J Clin Periodontol 32:130–138

    Article  PubMed  Google Scholar 

  24. Lora-Tamavo J, Senneville È, Ribera A, Bernard L, Dupon M et al (2017) The not-so-good prognosis of streptococcal periprosthetic joint infection managed by implant retention: the results of a large multicenter study. Clin Infect Dis 64:1742–1752

    Article  Google Scholar 

  25. Masini BD, Stinner DJ, Waterman SM, Wenke JC (2011) Bacterial adherence to suture materials. J Surg Educ 68:101–104

    Article  PubMed  Google Scholar 

  26. Melendez JM, Frankel YM, An AT, Williams L, Price LB, Wang NY, Lazarus GS, Zenilman JM (2010) Real-time PCR assays compared to culture-based approaches for identification of aerobic bacteria in chronic wounds. Clin Microbiol Infect 16:1762–1769

    Article  CAS  PubMed  Google Scholar 

  27. Morris MR, Bergum C, Jackson N, Markel DC (2017) Decreased bacterial adherence, biofilm formation, and tissue reactivity of barbed monofilament suture in an in vivo contaminated wound model. J Arthroplast 32:1272–1279

    Article  Google Scholar 

  28. Mounier R, Lobo D, Cook F, Fratani A, Attias A, Martin M, Chedevergne K, Bardon J, Tazi S, Nebbad B, Bloc S, Plaud B, Dhonneur G (2015) Clinical, biological, and microbiological pattern associated with ventriculostomy related infection: a retrospective longitudinal study. Acta Neurochir 157:2209–2217

    Article  PubMed  Google Scholar 

  29. Percival SL, Bowler P (2004) The potential significance of biofilms in wounds. Wounds 16:234–240

    Google Scholar 

  30. Schwieger F, Tebbe CC (1998) A new approach to utilize PCR-single-strand-conformation polymorphism for 16S rRNA gene-based microbial community analysis. Appl Environ Microbiol 64:4870–4876

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Serrano C, Garcia-Fernández L, Fernández-Blázquez JP, Barbeck M, Ghanaati S, Unger R, Kirkpatirck J, Arzt E, Funk L, Turón P, del Campo A (2015) Nanostructured medical sutures with antibacterial properties. Biomaterials 52:291–300

    Article  CAS  PubMed  Google Scholar 

  32. Snowden JN, Beaver M, Smeltzer MS, Kielian T (2012) Biofilm-infected intracerebroventricular shunts elicit inflammation within the central nervous system. Infect Immun 80:3206–3214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Söderquist B (2007) Surgical site infections in cardiac surgery: microbiology. APMIS 115:1008–1011

    Article  PubMed  Google Scholar 

  34. Swearingen MC, DiBartola AC, Dusane D, Granger J, Stoodley P (2016) 16S fRNA analysis provides evidence of biofilms on all components of three infected periprosthetic knees including permanent braided suture. Pathol Dis 74(7).https://doi.org/10.1093/femspd/ftw083

  35. Varma S, Ferguson HL, Breen H, Lumb WV (1974) Comparison of seven suture materials in infected wounds. An experimental study. J Surg Res 17:165–170

    Article  CAS  PubMed  Google Scholar 

  36. Veerachamy S, Yarlagadda T, Manivasagam G, Yarlagadda PK (2014) Bacterial adherence and biofilm formation on medical implants: a review. Proc Inst Mech Eng H 228:1083–1099

    Article  PubMed  Google Scholar 

  37. Voges J, Hilker R, Bötzel K, Kiening KL, Kloss M, Kupsch A, Schnitzler A, Schneider GH, Steude U, Deuschl G, Pinsker MO (2007) Thirty days complication rate following surgery performed for deep-brain-stimulation. Mov Disord 22:1486–1489

    Article  PubMed  Google Scholar 

  38. Yang S, Rothman RE (2004) PCR-based diagnostics for infectious diseases: uses, limitations, and future applications in acute-care settings. Lancet Infect Dis 4:337–378

    Article  CAS  PubMed  Google Scholar 

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Funding

No funding was received for this research.

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Correspondence to Bujung Hong.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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For this type of study formal approval is not required at our institution.

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Comments

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

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