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2.
J Shoulder Elbow Surg ; 28(10): 1848-1853, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31300367

RESUMO

BACKGROUND: Reducing intraoperative wound contamination is a critical preventive strategy for reducing the risk of prosthetic joint infection in shoulder arthroplasty. The aim of this study was to investigate the potential microbial colonization of subscapularis tagging sutures during shoulder arthroplasty. METHODS: In this prospective study, 50 consecutive patients undergoing primary shoulder arthroplasty (anatomic or reverse) were enrolled. Patients with revision shoulder arthroplasty and proximal humeral fractures were excluded. Nonabsorbable, braided tagging sutures were placed through the subscapularis tendon prior to tenotomy. A similar nonabsorbable, braided suture (control) was placed in a sterile container on the back table, open to the operating room environment. Subscapularis tagging sutures (experimental specimens) and control sutures were collected prior to subscapularis tenotomy repair and submitted for aerobic and anaerobic cultures. Cultures were held for 21 days to account for extended growth of slow-growing bacteria. RESULTS: A total of 12 of 50 experimental and 16 of 50 control sutures had positive cultures. Staphylococcus epidermidis and Cutibacterium acnes were the 2 most commonly isolated organisms. Active tobacco use (P = .038) and procedure length (P = .03) were significantly associated with positive cultures. No significant association between positive subscapularis tagging suture cultures and positive control cultures was found (P = .551). Patient age, sex, body mass index, and significant medical comorbidities were not significantly associated with positive cultures. DISCUSSION: Subscapularis tagging sutures are a potential source of microbial contaminant in shoulder arthroplasty, and we recommend exchanging the tagging suture with a suture opened immediately prior to subscapularis repair.


Assuntos
Artroplastia do Ombro/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Suturas/microbiologia , Idoso , Artroplastia do Ombro/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Propionibacterium acnes/isolamento & purificação , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco , Manguito Rotador/cirurgia , Staphylococcus epidermidis/isolamento & purificação , Suturas/efeitos adversos , Tenotomia , Uso de Tabaco
3.
Clin Orthop Relat Res ; 477(1): 116-126, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30794234

RESUMO

BACKGROUND: Irrigation and débridement are frequently utilized in the management of surgical infections, but even with aggressive débridement, it is difficult to remove all the suture material from the tissues and retained suture material may harbor bacteria and/or biofilm. The degree to which barbed or braided sutures may differentially influence the risk of infection has not been defined in a well-controlled animal model. QUESTIONS/PURPOSES: We compared braided and barbed monofilament sutures after irrigation of an infected mouse air pouch model to determine whether the suture type influenced the effectiveness of the irrigation. After irrigation of infected pouches, sutures were compared for (1) bacterial adherence and bacterial retention; (2) qualitative and quantitative pouch thickness and cellular density; and (3) quantitative biofilm formation. METHODS: Soft tissue air pouches were created on the backs of 60 female, mature 10-week-old BALB/cJ mice by sequentially introducing air into the subcutaneous tissue and allowing the pouch to mature. The pouches were inoculated with Staphylococcus aureus and braided or barbed monofilament sutures were implanted. Pouch irrigation was performed Day 7 after suture implantation. Suture segments were collected before and after irrigation. After euthanasia on Day 14, pouch tissues with residual suture segments were collected for analysis: microbiologic analysis done using optical density as a measure of the concentration of bacteria in the culture (the larger concentration indicates higher number of bacteria) and histologic evaluation of the pouch tissues were semiquantitative, whereas environmental scanning electron microscopy (ESEM) and confocal analyses of the biofilm and bacteria on the sutures were qualitative. RESULTS: Histologic evaluation of pouch tissue showed all groups had inflammatory responses. Quantitatively microbiology showed no difference in bacterial number calculated from the optical density (OD) values between the two suture materials at any time point in the irrigation group. In the no-irrigation group, for the Day 7 time point, mean (± SD) OD was greater in the barbed than the OD in the braided sutures (0.52 ± 0.12 versus 0.37 ± 0.16, mean difference 0.43 [95% confidence interval, 0.08-0.13]; p = 0.007). Qualitatively, ESEM showed more bacterial retention by braided sutures before and after irrigation. Confocal imaging of the sutures demonstrated penetration of biofilm into the interstices of braided sutures and less adhesion in barbed monofilament sutures. The quantification of the biomass showed no differences between groups at all time points (before-irrigation biomass was 11.2 ± 9.3 for braided versus 5.2 ± 4.7 for barbed sutures, p = 0.196; and after-irrigation biomass was 7.2 ± 7.5 for braided versus 3.3 ± 4.3 for barbed suture, p = 0.259). CONCLUSIONS: All sutures can retain bacteria and biofilm, but it is rarely possible to remove all suture material at the time of irrigation to treat infection. After an irrigation procedure, qualitatively braided sutures appeared to harbor more bacteria and to retain more biofilm than barbed monofilaments. CLINICAL RELEVANCE: When saline irrigation was used to simulate infection treatment in an infected mouse air pouch model, bacteria/biofilm was not completely eliminated from either braided or barbed monofilament sutures. The irrigation appeared to clear more bacteria and biofilm from the monofilament despite having barbs. Unfortunately, current technologies do not allow direct quantitative comparisons of biofilm retention. Clinicians should be aware that in the face of infection, any retained sutures may harbor bacteria despite irrigation.


Assuntos
Biofilmes/crescimento & desenvolvimento , Infecções Estafilocócicas/terapia , Staphylococcus aureus/crescimento & desenvolvimento , Infecção da Ferida Cirúrgica/terapia , Técnicas de Sutura/efeitos adversos , Técnicas de Sutura/instrumentação , Suturas/microbiologia , Irrigação Terapêutica , Animais , Aderência Bacteriana , Modelos Animais de Doenças , Desenho de Equipamento , Feminino , Camundongos Endogâmicos C57BL , Microscopia Confocal , Microscopia Eletrônica de Varredura , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/ultraestrutura , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Fatores de Tempo
4.
Clin Oral Investig ; 23(2): 559-565, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29717362

RESUMO

BACKGROUND: The aim of the study was to compare bacterial accumulation on different suture materials following oral surgery. METHODS: Patients scheduled for implant or periodontal surgery were included in the study. Upon flap closure, four different sutures were placed in a randomized sequence-silk, coated polyglactin, nylon, and polyester. Ten days following surgery, the sutures were removed and incubated in aerobic as well as anaerobic conditions for 7 days and colony-forming units (CFUs) were calculated. Association between bacterial accumulation and periodontal diagnosis, type of surgery, and antibiotic treatment were also tested. RESULTS: All sutures in all patients were found to contain bacteria. Overall, nylon sutures showed significantly lower CFU levels compared to silk, coated polyglactin, and polyester sutures. The type of surgery (implant vs. periodontal surgery) did not significantly influence bacterial accumulation. Also, periodontal diagnosis had little impact on CFU counts. Interestingly, post-surgical antibiotic treatment also had only a minor effect on bacterial accumulation on the various sutures. DISCUSSION: The results indicate that the monofilamentous nylon sutures showed less microbial accumulation than the other tested materials that were all braided. This effect may be due to material qualities as well as suture macrostructure. Type of surgery, periodontal diagnosis, and antibiotic consumption have little effect on bacterial accumulation of sutures. CLINICAL RELEVANCE: The study provides the microbial profile of commonly used sutures and may assist in suture selection during clinical procedures.


Assuntos
Aderência Bacteriana , Procedimentos Cirúrgicos Bucais , Suturas/microbiologia , Adulto , Idoso , Materiais Revestidos Biocompatíveis , Feminino , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Nylons , Poliésteres , Poliglactina 910 , Seda , Células-Tronco
5.
Macromol Biosci ; 18(12): e1800262, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30408337

RESUMO

Surgical site infections (SSI) represent a serious health problem that occur after invasive surgery, thus new antimicrobial biomaterials able to prevent SSI are needed. Silks are natural biopolymers with excellent biocompatibility, low immunogenicity and controllable biodegradability. Spider silk-based materials can be bioengineered and functionalized with specific peptides, such as antimicrobial peptides, creating innovative polymers. Herein, we explored new drug-free multifunctional silk films with antimicrobial properties, specifically tailored to hamper microbial infections. Different spider silk domains derived from the dragline sequence of the spider Nephila clavipes (6mer and 15mer, 27 and 41 kDa proteins, respectively) were fused with the two antimicrobial peptides, Hepcidin (Hep) and Human Neutrophil peptide 1 (HNP1). The self-assembly features of the spider silk domains (ß-sheets) were maintained after functionalization. The bioengineered 6mer-HNP1 protein demonstrated inhibitory effects against microbial pathogens. Silk-based films with 6mer-HNP1 and different contents of silk fibroin (SF) significantly reduced bacterial adhesion and biofilm formation, whereas higher bacterial counts were found on the films prepared with 6mer or SF alone. The silk-based films showed no cytotoxic effects on human foreskin fibroblasts. The positive cellular response, together with structural and antimicrobial properties, highlight the potential of these multifunctional silk-based films as new materials for preventing SSI.


Assuntos
Anti-Infecciosos/química , Materiais Biocompatíveis/química , Fibroínas/química , Hepcidinas/biossíntese , Proteínas Recombinantes de Fusão/química , alfa-Defensinas/biossíntese , Animais , Anti-Infecciosos/metabolismo , Anti-Infecciosos/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Materiais Biocompatíveis/metabolismo , Materiais Biocompatíveis/farmacologia , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Candida albicans/crescimento & desenvolvimento , Linhagem Celular , Sobrevivência Celular , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Fibroínas/biossíntese , Fibroínas/genética , Fibroínas/farmacologia , Expressão Gênica , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/crescimento & desenvolvimento , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/crescimento & desenvolvimento , Hepcidinas/genética , Hepcidinas/farmacologia , Humanos , Viabilidade Microbiana/efeitos dos fármacos , Plasmídeos/química , Plasmídeos/metabolismo , Polimerização , Conformação Proteica em Folha beta , Proteínas Recombinantes de Fusão/biossíntese , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/farmacologia , Aranhas/fisiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas/microbiologia , alfa-Defensinas/genética , alfa-Defensinas/farmacologia
6.
Asian Cardiovasc Thorac Ann ; 26(7): 540-545, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30185073

RESUMO

Objective It has been reported previously that granulomas can occur around nonabsorbable sutures, but that granuloma formation around the staple line is very rare. However, the increased use of thoracoscopic surgery is creating more opportunities to use automatic mechanical suturing equipment for pulmonary surgery, and it is expected that the incidence of granuloma around the staple line will increase. Methods We retrospectively investigated the clinical records of 6 patients who developed nontuberculous mycobacterial granuloma on the staple line after pulmonary resection. We investigated their clinical characteristics and compared them with data in 16 cases of cancer recurrence. Results Fluorodeoxyglucose uptake was detected in all 6 patients. Laboratory data including white blood cell counts and C-reactive protein levels were within normal ranges in all patients. There was no evident tendency in terms of age, sex, maximal standardized uptake value, or radiological findings. However, compared to cancer recurrence, mycobacterial granuloma around the staple line appeared after a longer period of time, and the proportion of patients who had a segmentectomy as the initial surgery was significantly higher. Conclusion When growing shadows are observed near the staple line, it is difficult to differentiate between cancer recurrence and nontuberculous mycobacterial granuloma from computed tomography and laboratory findings. However, if a mass shadow around the staple line appears 2, 3, or more years after segmentectomy, it could be considered likely to be a granuloma. "Post-segmentectomy" and "late occurrence" are important attributes for distinguishing staple line granuloma from cancer recurrence.


Assuntos
Granuloma/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Pneumonectomia/efeitos adversos , Grampeamento Cirúrgico/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Suturas/microbiologia , Idoso , Feminino , Seguimentos , Granuloma/diagnóstico , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Suturas/efeitos adversos , Cirurgia Torácica Vídeoassistida/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X
7.
Br J Ophthalmol ; 102(11): 1602-1606, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30100555

RESUMO

AIM: To investigate the relationships between corneal suture bacteriology, biofilm and the clinical setting using culture studies and scanning electron microscopy (SEM). METHODS: This is a prospective, observational study of patients with a history of penetrating keratoplasty presenting to a tertiary cornea clinic for routine or symptoms-related corneal suture removal. We documented for each patient the suture clinical setting (quiescent, exposed and keratitis-related), retention time, antimicrobial therapy, bacterial growth on culture studies, and bacterial presence and biofilm coverage on SEM. RESULTS: There were significantly different culture positivity rates between the quiescent (8%), exposed (12%) and keratitis-related (60%) suture groups (p=0.039). As expected, keratitis-related sutures had the longest retention time compared with quiescent and exposed ones (p=0.02). The biofilm coverage score was higher for sutures from the keratitis-related and exposed groups, although this trend was not statistically significant (p=0.90). Higher biofilm scores were seen in samples that also yielded a positive culture result (p=0.36) and in samples with bacterial presence on SEM images (p=0.16 and p=0.73). Both of these were important trends but not statistically significant. CONCLUSIONS: Evidence for active bacterial and biofilm presence on corneal sutures was found. Corneal sutures should be considered for removal sooner, before becoming exposed and/or keratitis-related. Traditional culture studies and SEM imaging are helpful in investigating biofilm and its clinical importance. More studies of the spectrum of bacterial growth on embedded biomedical devices such as corneal sutures are needed.


Assuntos
Bactérias/isolamento & purificação , Biofilmes/crescimento & desenvolvimento , Infecções Oculares Bacterianas/microbiologia , Ceratite/microbiologia , Ceratoplastia Penetrante , Suturas/microbiologia , Bactérias/ultraestrutura , Técnicas Bacteriológicas , Córnea/microbiologia , Humanos , Microscopia Eletrônica de Varredura , Estudos Prospectivos
8.
Obes Surg ; 28(10): 3352-3359, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30030727

RESUMO

BACKGROUND: While there are various techniques to create the gastrojejunostomy during a laparoscopic Roux-en-Y gastric bypass (LRYGB), many surgeons prefer using a circular stapler. One drawback of this method, however, is the higher incidence of surgical site infections (SSIs). To investigate the effect of a dual ring wound protector on SSIs during LRYGB. METHODS: In April 2016, our bariatric surgical group implemented an intervention whereby a dual ring wound protector in conjunction with a conical EEA stapler introducer was used when creating the gastrojejunostomy. SSIs from pre- and post-intervention were compared using Fisher's exact test. Only LRYGBs performed with a circular stapler were included in our analysis. Student's t test and χ2 were used to compare pre- and post-intervention groups with respect to demographics and co-morbidities. RESULTS: Between April 2015 and January 31st, 2017, our surgeons performed 158 LRYGBs using a circular stapler for the gastrojejunostomy. There were 84 patients (53%) in the pre-intervention group and 74 (47%) in the post-intervention group. The pre- and post-intervention groups were not statistically different. The SSI rate for the pre-intervention group was 9.5% while the SSI rate was 1.35% in the post-intervention group (p = 0.0371). The use of a dual ring wound protector for LRYGBs with circular stapled gastrojejunostomy was associated with an 86% relative risk reduction in SSIs. CONCLUSION: Using a dual ring wound protector in conjunction with a conical EEA introducer for LRYGBs with circular stapled gastrojejunostomy significantly decreased SSIs.


Assuntos
Derivação Gástrica/efeitos adversos , Laparoscopia/efeitos adversos , Obesidade Mórbida/cirurgia , Equipamentos de Proteção , Equipamentos Cirúrgicos , Infecção da Ferida Cirúrgica/prevenção & controle , Suturas , Adulto , Contaminação de Equipamentos/prevenção & controle , Desenho de Equipamento , Feminino , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Derivação Gástrica/estatística & dados numéricos , Humanos , Incidência , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Equipamentos de Proteção/estatística & dados numéricos , Estudos Retrospectivos , Equipamentos Cirúrgicos/efeitos adversos , Equipamentos Cirúrgicos/microbiologia , Equipamentos Cirúrgicos/estatística & dados numéricos , Instrumentos Cirúrgicos/efeitos adversos , Instrumentos Cirúrgicos/microbiologia , Instrumentos Cirúrgicos/estatística & dados numéricos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/instrumentação , Grampeamento Cirúrgico/métodos , Grampeamento Cirúrgico/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Suturas/efeitos adversos , Suturas/microbiologia , Suturas/estatística & dados numéricos
9.
Surg Infect (Larchmt) ; 19(4): 430-437, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29624479

RESUMO

BACKGROUND: This study evaluated the in vitro and in vivo anti-bacterial efficacy of STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Devices in comparison with standard absorbable polydioxanone devices lacking triclosan, utilizing challenges by gram-positive and gram-negative bacteria. METHODS: The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device was tested for in vitro efficacy against Staphylococcus aureus, methicillin-resistant S. aureus (MRSA), S. epidermidis, methicillin-resistant S. epidermidis (MRSE), Klebsiella pneumoniae, and Escherichia coli using a zone of inhibition (ZOI) assay. The ZOI was used to determine: immediate anti-bacterial efficacy at 24 hours, sustained efficacy for as long as 23 days, and stability for as long as 36 months. Bacterial colonization of the device in vitro was evaluated by scanning electron microscopy and enumerating viable adherent bacteria, expressed as colony-forming units (CFU) per centimeter on the device. In vivo evaluations were conducted in guinea pigs and mice where 3 to 4 cm of the test device and the control suture (commercial Quill™ PDO without triclosan) were implanted subcutaneously through separate catheters into opposite sides of the dorsolateral region. Each implantation site was challenged directly through the indwelling catheter with 106 CFU of S. aureus (guinea pigs) or 107 CFU of E. coli (mice). At 48 hours post-implantation, the test device and control suture were explanted for bacterial enumeration. RESULTS: The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device demonstrated in vitro anti-bacterial activity against all test organisms. This activity was maintained for 11 and 23 days when tested against E. coli and S. aureus, respectively. The device was not colonized by test bacteria in vitro. The anti-bacterial activity remained stable for as long as 36 months of storage at 30°C and 75% relative humidity. In vivo evaluation in animal models demonstrated a 1.16-log reduction in S. aureus and a 1.83-log reduction in E. coli relative to the control device. (p < 0.05) Conclusion: The STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device exhibited anti-bacterial efficacy in vitro against a wide range of clinically significant bacterial species with long-lasting inhibition of colonization by S. aureus, and E. coli. It inhibited colonization by S. aureus and E. coli in vitro and in vivo. Thus, the STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device represents a powerful technology to help mitigate one of the risk factors for surgical site infections.


Assuntos
Anti-Infecciosos Locais/farmacologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Positivas/prevenção & controle , Polidioxanona , Suturas/microbiologia , Triclosan/farmacologia , Animais , Contagem de Colônia Microbiana , Feminino , Cobaias , Masculino , Camundongos , Testes de Sensibilidade Microbiana , Microscopia Eletrônica de Varredura
10.
Arthroscopy ; 34(4): 1151-1155, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29373294

RESUMO

PURPOSE: To examine the contamination rate of the anchor-suture and to determine the efficacy of 2 different surgical skin preparation solutions with or without a plastic adhesive drape from suture contamination in arthroscopic rotator cuff repair. METHODS: A prospective randomized study was undertaken to evaluate 126 consecutive patients undergoing arthroscopic rotator cuff repair. Each shoulder was prepared with one of 2 randomly selected solutions according to an assigned envelope that indicated the procedure to be used: chlorhexidine-alcohol (1% chlorhexidine gluconate and 70% isopropyl alcohol) or povidone-iodine. Then, each group was further divided according to the usage of a plastic drape. The first cut-tails of the anchor-suture after cuff fixation were submitted to aerobic and anaerobic cultures. RESULTS: The overall rate of Propionibacterium acnes-positive cultures was 47% (14 of 31 cases) in the povidone-iodine group, 33% (11 of 33 cases) in the povidone-iodine with a drape group, 33% (10 of 30 cases) in the chlorhexidine-alcohol group, and 9.3% (3 of 32 cases) in the chlorhexidine-alcohol with a drape group. The positive culture rate in the chlorhexidine-alcohol with a drape group was lower than that in the povidone-iodine group (relative risk, 0.2; 95% confidence interval: 0.064-0.63; number needed to treat, 2.7; P < .0001). Coagulase-negative staphylococci were isolated in the povidone-iodine with a drape (1 case) and chlorhexidine-alcohol with a drape group (2 cases). No other bacteria were isolated, and no infections occurred in any of the patients treated in this study during the minimum 12-month follow-up period. CONCLUSIONS: Chlorhexidine-alcohol solution with an adhesive plastic drape was more effective than chlorhexidine-alcohol without a plastic drape and povidone-iodine with/without a plastic drape in eliminating P acnes suture contamination. However, the usage of a plastic drape slightly increased the risk of coagulase-negative Staphylococcus proliferation. LEVEL OF EVIDENCE: Level I, therapeutic, prospective, randomized trial.


Assuntos
2-Propanol/administração & dosagem , Clorexidina/análogos & derivados , Contaminação de Equipamentos/prevenção & controle , Povidona-Iodo/administração & dosagem , Propionibacterium acnes/isolamento & purificação , Campos Cirúrgicos , Suturas/microbiologia , Idoso , Anti-Infecciosos Locais/administração & dosagem , Clorexidina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Lesões do Manguito Rotador/cirurgia , Staphylococcus/isolamento & purificação , Âncoras de Sutura
11.
Acta Neurochir (Wien) ; 160(3): 497-503, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29189910

RESUMO

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.


Assuntos
Bactérias , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Suturas/microbiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , DNA Bacteriano/genética , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo Conformacional de Fita Simples , Estudos Prospectivos , RNA Ribossômico 16S/genética , Cicatrização , Adulto Jovem
12.
J Surg Res ; 220: 268-274, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29180191

RESUMO

BACKGROUND: Surgical site infection (SSI) is a common complication of surgical procedures. AIM: Our study aimed at investigating a new method based on assessment of suture thread colonization to identify patients developing an SSI. MATERIALS AND METHODS: We prospectively enrolled 119 patients undergoing elective surgery. For each patient, a synthetic absorbable thread in Lactomer 9-1 (Polisorb Gauge 2) inserted in the surgical site at the end of surgery was sent to the microbiology laboratory after 48 h to assess colonization of its inner tract. RESULTS: Forty (33.6% of cases) patients had a colonized thread. Antibiotic prophylaxis was administered to 66 of 79 patients who did not display a colonized thread and to 20 of the 40 patients with a colonized thread (83.5% versus 50%, respectively, P = 0.0002). An SSI was observed only in patients with a colonized thread (10% versus 0, P = 0.02). The microorganisms identified in colonized threads were the same identified in SSIs. CONCLUSIONS: Since an SSI was found only in patients with colonized threads, the method described here may be valuable for identifying patients developing an SSI. Moreover, the method can also be useful for targeting efficient antibiotic therapy to the culprit microorganisms.


Assuntos
Infecção da Ferida Cirúrgica/diagnóstico , Suturas/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/microbiologia , Adulto Jovem
13.
Acta Cir Bras ; 32(8): 680-690, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28902944

RESUMO

Purpose:: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods:: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device). Displacement, kinking, fixation failure, hyperemia at the insertion site, purulent secretion, loss of the device, psychomotor agitation, mental confusion, and bacterial growth at the insertion site were evaluated. Results: : Compared with the Wing group, the Shoelace group had a lower occurrence of catheter displacement (n=0 versus n =4; p = 0.04), kinking (n=0 versus n=8; p=0.001), and fixation failure (n=2 versus n=8; p=0.018). No significant difference was found in bacterial growth (n=20 versus n=14; p=0.267) between groups. Conclusion: : The Shoelace fixation technique presented fewer adverse events than the Wing fixation technique.


Assuntos
Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Técnicas de Sutura/instrumentação , Suturas , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Método Simples-Cego , Estatísticas não Paramétricas , Técnicas de Sutura/efeitos adversos , Suturas/microbiologia , Fatores de Tempo
14.
Lab Med ; 48(3): e36-e41, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28934511

RESUMO

M. abscessus complex is notoriously resistant to most antimicrobial agents. The complex is differentiated into 3 subspecies: M. abscessus subsp. abscessus, M. abscessus subsp. massiliense, and M. abscessus subsp. bolletii. Skin and soft tissue infections due to this organism can be acquired by direct contact with contaminated material through traumatic injury, surgical wound and environmental exposure or by secondary involvement of skin/soft tissue during disseminated disease. We report a case of Mycobacterium abscessus infection recovered from a post-operative mid-line abdominal wound to illustrate the diagnostic and management difficulties encountered in such patients.


Assuntos
Infecções por Micobactéria não Tuberculosa , Mycobacterium abscessus , Infecção da Ferida Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade , Suturas/microbiologia
15.
Acta cir. bras ; 32(8): 680-690, Aug. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886228

RESUMO

Abstract Purpose: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device). Displacement, kinking, fixation failure, hyperemia at the insertion site, purulent secretion, loss of the device, psychomotor agitation, mental confusion, and bacterial growth at the insertion site were evaluated. Results: Compared with the Wing group, the Shoelace group had a lower occurrence of catheter displacement (n=0 versus n =4; p = 0.04), kinking (n=0 versus n=8; p=0.001), and fixation failure (n=2 versus n=8; p=0.018). No significant difference was found in bacterial growth (n=20 versus n=14; p=0.267) between groups. Conclusion: The Shoelace fixation technique presented fewer adverse events than the Wing fixation technique.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Suturas , Cateterismo Venoso Central/métodos , Técnicas de Sutura/instrumentação , Cateteres Venosos Centrais , Suturas/microbiologia , Índice de Gravidade de Doença , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Método Simples-Cego , Estudos Prospectivos , Reprodutibilidade dos Testes , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Distribuição por Sexo , Estatísticas não Paramétricas , Unidades de Terapia Intensiva
16.
J Biomater Appl ; 32(3): 384-398, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28750601

RESUMO

Braided polyamide sutures are frequently used in dermatologic surgery for wound closure. However, braided sutures promote bacteria proliferation. In order to prevent wound complications due to this effect, antibacterial sutures should be used. The main objective of this study is the development of new non-absorbable antibacterial polyamide braided suture. This paper suggests new coating process that leads to obtain suture uniformly covered by antibacterial film enclosing chitosan, which is known for its antibacterial benefit. Mechanical properties and surface morphology of developed sutures were investigated by using mechanical tests. Sutures surfaces were also examined by scanning electron microscope, to perceive spreading of coating product on suture surface. In order to identify potential reactions between chemical compounds present in coating solution and suture material, sutures were analyzed by ATR-IF spectroscopy. It has been demonstrated that many eventual bonds between compounds present in coating solutions and polyamide macromolecular chain may occur. The existence of these bonds implies the fixation of biopolymer coating on suture surface. It has been demonstrated that uniform surface may be obtained by progressively applying coating solution containing little amount of chitosan on suture surface. We have also found that developed coating process has not affected mechanical properties of suture, which still meet United States Pharmacopeia requirement. Finally, antibacterial effects against four colonies, very widespread in hospitals, were studied. Prominent antibacterial effects of braided polyamide suture against two gram-positive ( S Aureus, S epidermidis) and two gram-negative ( E coli and P aeruginosa) colonies are presented. Optimal result of best properties is obtained by applying three layers of biopolymer coating comprising 1% chitosan and 10% citric acid. The new developed suture coating process appears as a promising method for obtaining important antibacterial effect with smooth suture surface.


Assuntos
Antibacterianos/química , Quitosana/análogos & derivados , Ácido Cítrico/análogos & derivados , Materiais Revestidos Biocompatíveis/química , Nylons/química , Suturas/microbiologia , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Infecções Bacterianas/prevenção & controle , Quitosana/farmacologia , Ácido Cítrico/farmacologia , Materiais Revestidos Biocompatíveis/farmacologia , Humanos , Nylons/farmacologia , Resistência à Tração
17.
Ann Clin Microbiol Antimicrob ; 16(1): 39, 2017 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-28511708

RESUMO

BACKGROUND: Silver nanoparticles (AgNPs) are believed to be emerging tool against various infectious diseases including multi-drug resistant (MDR) bacteria. In the present study, in vitro synthesis of AgNPs was optimized using 1:50 ratio of macerozyme (25 µg/µl) and 1 mM AgNO3 incubated at 80 °C for 8 h. AgNPs were characterized by UV-Visible spectroscopy, dynamic light scattering (DLS), scanning electron microscopy, energy-dispersive X-ray spectroscopy, transmission electron microscopy (TEM) and X-ray diffraction (XRD). RESULTS: Characterization studies suggest the synthesis of elliptical, stable and crystalline AgNPs with an average size of 38.26 ± 0.4 nm calculated using TEM. The XRD pattern revealed the face-centered-cubic (fcc) form of metallic silver. Good shape integrity and dispersion of AgNPs after 1 year of incubation confirmed their stability. AgNPs were exibited the antimicrobial property against ten pathogenic bacteria, three molds and one yeast. The AgNPs also revealed remarkable antimicrobial activity against three MDR strains i.e. Extended spectrum beta-lactamase positive Escherichia coli, Staphylococcus aureus (MRSA) and Teicoplanin resistant Streptococcus Pneumoniae. The AgNPs coated surgical threads (suture) were revealed the remarkble antibacterial activity against three MDR strains. This is the first report to synthesize antimicrobial elliptical AgNPs using enzymes. CONCLUSION: The results suggest the possibilities to develop the nanoparticles coated antimicrobial medical fabric to combat against MDR infection.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Nanopartículas Metálicas/química , Prata/química , Prata/farmacologia , Antibacterianos/química , Anti-Infecciosos/química , Anti-Infecciosos/farmacologia , Bactérias/efeitos dos fármacos , Materiais Revestidos Biocompatíveis , Escherichia coli/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Tamanho da Partícula , Staphylococcus aureus/efeitos dos fármacos , Streptococcus pneumoniae/efeitos dos fármacos , Equipamentos Cirúrgicos/microbiologia , Suturas/microbiologia , Leveduras/efeitos dos fármacos
18.
Can J Vet Res ; 81(1): 69-72, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28154467

RESUMO

The objective of this study was to investigate whether cleaning surgical materials used to close pelvic flexure enterotomies with a wet sterile gauze will reduce contamination and whether the use of a full thickness appositional suture pattern (F) or a partial thickness inverting (or Cushing) suture pattern (C) would make a difference in the level of contamination. Large colon specimens were assigned to group F or C and divided into subgroups N and G. In group G, a wet sterile gauze was passed over the suture material, another over the instruments, and another over the gloves. In group N, no treatment was applied. The bacterial concentration was measured by optical density (OD) at 24 h. The OD of subgroup CG was lower than that of subgroup CN (P = 0.019). The OD of subgroup FG was lower than that of subgroup FN (P = 0.02). The OD of subgroups CG, CN, FG, and FN was lower than that of the negative control (P < 0.003, P < 0.001, P < 0.001, and P < 0.00). The use of a sterile wet gauze significantly reduced contamination of suture materials. A partial thickness inverting suture pattern did not produce less contamination than a full thickness appositional suture pattern.


Assuntos
Colo/cirurgia , Enterostomia/veterinária , Luvas Cirúrgicas/veterinária , Cavalos/cirurgia , Instrumentos Cirúrgicos/veterinária , Suturas/microbiologia , Animais , Bactérias , Luvas Cirúrgicas/microbiologia , Instrumentos Cirúrgicos/microbiologia
19.
Minerva Stomatol ; 66(1): 28-34, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27583530

RESUMO

BACKGROUND: Suture is the final act of most oral surgery procedures. The quality of healing after the operation depends on its efficiency. Sutures must not cause inflammation - neither directly nor indirectly. The objective of this study is to compare the bacterial colonization on different suture materials after a third molar extraction. METHODS: Thirty patients were randomly selected among people going under third molar extraction; they were divided into 3 groups and one suture type was used on each group. After 7 days distal stitches were removed by a single operator, placed in physiologic solution and analyzed after 2 or 3 hours. Patients followed the same postsurgical protocols; materials used were: Ethicon Silk® 4/0, B. Braun Dafilon® 4/0, and B. Braun Safil® 4/0. RESULTS: The amount of cocci and bacilli on the sutures analyzed shows that silk (Ethicon Silk) is the higher level of retention material where monofilament (B. Braun Dafilon) is the lower. There is a difference between monofilament and polyglycolide (B. Braun Safil), as the former is less retentive than the latter, although not significantly so. CONCLUSIONS: A less plaque retention, and consequently a fewer bacterial presence, is crucial to minimize the inflammatory process and allow a better tissue healing. Since the capability of brushing and, of course, the final personal hygiene depends on multiple variables, we must use surgical protocols able to minimize the effect of improper cleaning on the healing process: this statement implies the use of low plaque retention materials. The use of monofilament or polyglycolide threads in sutures can help reducing bacterial concentration and therefore promotes a faster and better healing.


Assuntos
Bactérias/isolamento & purificação , Biofilmes , Placa Dentária/microbiologia , Nylons , Ácido Poliglicólico , Seda , Suturas/microbiologia , Extração Dentária , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dente Serotino/cirurgia , Higiene Bucal , Amostragem , Cicatrização , Adulto Jovem
20.
Indian J Dent Res ; 27(5): 535-539, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27966513

RESUMO

BACKGROUND: Surgical site plaque accumulation is one of the challenging problems leading to unfavorable healing. The antibacterial sutures can be used to reduce or inhibit plaque formation. Presently there is no study comparing efficacy of sutures coated with triclosan and chlorhexidine in terms of oral biofilm inhibition and antimicrobial property against periodontal pathogens. AIM: The aim of present study was to evaluate the antibacterial efficacy and oral biofilm inhibition around chlorhexidine and triclosan coated polyglactin sutures in comparison to uncoated sutures. MATERIALS AND METHOD: Equal segments of chlorhexidine and triclosan coated polyglactin sutures (3-0) were incubated at 370°C in saliva collected from 10 chronic periodontitis patients for 7 days. Plain uncoated suture served as control. Biofilm formation was analyzed with Confocal Laser-Scanning Microscopy (CLSM) and Scanning Electron Microscopy (SEM). Quantitative assessment was done using Colony Forming Units (CFU/mL).The antibacterial efficacy of the sutures was tested against specific periodontal pathogens (S.mutans, F.nucleatum, A.actinomycetomcomitans, P.intermedia, P.gingivalis) using agar diffusion method. CLSM and SEM were not subjected to statistical analysis. ANOVA test was used for colony forming units and agar diffusion test. (P < 0.05) Results: CLSM and SEM showed substantial biofilm inhibition around chlorhexidine-coated sutures followed by triclosan-coated when compared to plain uncoated suture. The antibacterial coated sutures showed statistically significant difference in CFUs/ml and zone of inhibition compared to plain uncoated sutures. Among coated sutures, chlorhexidine-coated sutures showed better results. CONCLUSION: The antibacterial coated sutures have a promising potential in preventing the colonization of periodontal pathogens around it thereby inhibiting biofilm formation.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Biofilmes/efeitos dos fármacos , Clorexidina/uso terapêutico , Suturas , Triclosan/uso terapêutico , Humanos , Técnicas In Vitro , Microscopia Confocal , Microscopia Eletrônica de Varredura , Periodontite/microbiologia , Periodontite/prevenção & controle , Suturas/microbiologia
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