First evidence of sternal wound biofilm following cardiac surgery.

Management of deep sternal wound infection (SWI), a serious complication after cardiac surgery with high morbidity and mortality incidence, requires invasive procedures such as, debridement with primary closure or myocutaneous flap reconstruction along with use of broad spectrum antibiotics. The pur...

Full description

Bibliographic Details
Main Authors: Haytham Elgharably, Ethan Mann, Hamdy Awad, Kasturi Ganesh, Piya Das Ghatak, Gayle Gordillo, Chittoor B Sai-Sudhakar, Sashwati Roy, Daniel J Wozniak, Chandan K Sen
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2013-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC3731358?pdf=render
id doaj-809d9e8a70534124bb3f5b94cc080950
record_format Article
spelling doaj-809d9e8a70534124bb3f5b94cc0809502020-11-24T22:12:52ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0188e7036010.1371/journal.pone.0070360First evidence of sternal wound biofilm following cardiac surgery.Haytham ElgharablyEthan MannHamdy AwadKasturi GaneshPiya Das GhatakGayle GordilloChittoor B Sai-SudhakarSashwati RoyDaniel J WozniakChandan K SenManagement of deep sternal wound infection (SWI), a serious complication after cardiac surgery with high morbidity and mortality incidence, requires invasive procedures such as, debridement with primary closure or myocutaneous flap reconstruction along with use of broad spectrum antibiotics. The purpose of this clinical series is to investigate the presence of biofilm in patients with deep SWI. A biofilm is a complex microbial community in which bacteria attach to a biological or non-biological surface and are embedded in a self-produced extracellular polymeric substance. Biofilm related infections represent a major clinical challenge due to their resistance to both host immune defenses and standard antimicrobial therapies. Candidates for this clinical series were patients scheduled for a debridement procedure of an infected sternal wound after a cardiac surgery. Six patients with SWI were recruited in the study. All cases had marked dehiscence of all layers of the wound down to the sternum with no signs of healing after receiving broad spectrum antibiotics post-surgery. After consenting patients, tissue and/or extracted stainless steel wires were collected during the debridement procedure. Debrided tissues examined by Gram stain showed large aggregations of Gram positive cocci. Immuno-fluorescent staining of the debrided tissues using a specific antibody against staphylococci demonstrated the presence of thick clumps of staphylococci colonizing the wound bed. Evaluation of tissue samples with scanning electron microscope (SEM) imaging showed three-dimensional aggregates of these cocci attached to the wound surface. More interestingly, SEM imaging of the extracted wires showed attachment of cocci aggregations to the wire metal surface. These observations along with the clinical presentation of the patients provide the first evidence that supports the presence of biofilm in such cases. Clinical introduction of the biofilm infection concept in deep SWI may advance the current management strategies from standard antimicrobial therapy to anti-biofilm strategy.http://europepmc.org/articles/PMC3731358?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Haytham Elgharably
Ethan Mann
Hamdy Awad
Kasturi Ganesh
Piya Das Ghatak
Gayle Gordillo
Chittoor B Sai-Sudhakar
Sashwati Roy
Daniel J Wozniak
Chandan K Sen
spellingShingle Haytham Elgharably
Ethan Mann
Hamdy Awad
Kasturi Ganesh
Piya Das Ghatak
Gayle Gordillo
Chittoor B Sai-Sudhakar
Sashwati Roy
Daniel J Wozniak
Chandan K Sen
First evidence of sternal wound biofilm following cardiac surgery.
PLoS ONE
author_facet Haytham Elgharably
Ethan Mann
Hamdy Awad
Kasturi Ganesh
Piya Das Ghatak
Gayle Gordillo
Chittoor B Sai-Sudhakar
Sashwati Roy
Daniel J Wozniak
Chandan K Sen
author_sort Haytham Elgharably
title First evidence of sternal wound biofilm following cardiac surgery.
title_short First evidence of sternal wound biofilm following cardiac surgery.
title_full First evidence of sternal wound biofilm following cardiac surgery.
title_fullStr First evidence of sternal wound biofilm following cardiac surgery.
title_full_unstemmed First evidence of sternal wound biofilm following cardiac surgery.
title_sort first evidence of sternal wound biofilm following cardiac surgery.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2013-01-01
description Management of deep sternal wound infection (SWI), a serious complication after cardiac surgery with high morbidity and mortality incidence, requires invasive procedures such as, debridement with primary closure or myocutaneous flap reconstruction along with use of broad spectrum antibiotics. The purpose of this clinical series is to investigate the presence of biofilm in patients with deep SWI. A biofilm is a complex microbial community in which bacteria attach to a biological or non-biological surface and are embedded in a self-produced extracellular polymeric substance. Biofilm related infections represent a major clinical challenge due to their resistance to both host immune defenses and standard antimicrobial therapies. Candidates for this clinical series were patients scheduled for a debridement procedure of an infected sternal wound after a cardiac surgery. Six patients with SWI were recruited in the study. All cases had marked dehiscence of all layers of the wound down to the sternum with no signs of healing after receiving broad spectrum antibiotics post-surgery. After consenting patients, tissue and/or extracted stainless steel wires were collected during the debridement procedure. Debrided tissues examined by Gram stain showed large aggregations of Gram positive cocci. Immuno-fluorescent staining of the debrided tissues using a specific antibody against staphylococci demonstrated the presence of thick clumps of staphylococci colonizing the wound bed. Evaluation of tissue samples with scanning electron microscope (SEM) imaging showed three-dimensional aggregates of these cocci attached to the wound surface. More interestingly, SEM imaging of the extracted wires showed attachment of cocci aggregations to the wire metal surface. These observations along with the clinical presentation of the patients provide the first evidence that supports the presence of biofilm in such cases. Clinical introduction of the biofilm infection concept in deep SWI may advance the current management strategies from standard antimicrobial therapy to anti-biofilm strategy.
url http://europepmc.org/articles/PMC3731358?pdf=render
work_keys_str_mv AT haythamelgharably firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT ethanmann firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT hamdyawad firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT kasturiganesh firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT piyadasghatak firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT gaylegordillo firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT chittoorbsaisudhakar firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT sashwatiroy firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT danieljwozniak firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
AT chandanksen firstevidenceofsternalwoundbiofilmfollowingcardiacsurgery
_version_ 1725802004125581312