First Evidence of Sternal Wound Biofilm following Cardiac Surgery

Haytham Elgharably, Ethan Mann, Hamdy Awad, Kasturi Ganesh, Piya Das Ghatak, Gayle Gordillo, Chittoor Sai Sudhakar, Sashwati Roy, Daniel J. Wozniak, Chandan K. Sen

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Article numbere70360
JournalPloS one
Volume8
Issue number8
DOIs
StatePublished - Aug 1 2013

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Biofilms
plant damage
biofilm
Surgery
Thoracic Surgery
surgery
Wound Infection
Wounds and Injuries
Debridement
debridement
Tissue
Coccus
wire
Wire
infection
Staphylococcus
Electron microscopes
Agglomeration
scanning electron microscopes
Electrons

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Elgharably, H., Mann, E., Awad, H., Ganesh, K., Ghatak, P. D., Gordillo, G., ... Sen, C. K. (2013). First Evidence of Sternal Wound Biofilm following Cardiac Surgery. PloS one, 8(8), [e70360]. https://doi.org/10.1371/journal.pone.0070360

First Evidence of Sternal Wound Biofilm following Cardiac Surgery. / Elgharably, Haytham; Mann, Ethan; Awad, Hamdy; Ganesh, Kasturi; Ghatak, Piya Das; Gordillo, Gayle; Sai Sudhakar, Chittoor; Roy, Sashwati; Wozniak, Daniel J.; Sen, Chandan K.

In: PloS one, Vol. 8, No. 8, e70360, 01.08.2013.

Research output: Contribution to journalArticle

Elgharably, H, Mann, E, Awad, H, Ganesh, K, Ghatak, PD, Gordillo, G, Sai Sudhakar, C, Roy, S, Wozniak, DJ & Sen, CK 2013, 'First Evidence of Sternal Wound Biofilm following Cardiac Surgery', PloS one, vol. 8, no. 8, e70360. https://doi.org/10.1371/journal.pone.0070360
Elgharably H, Mann E, Awad H, Ganesh K, Ghatak PD, Gordillo G et al. First Evidence of Sternal Wound Biofilm following Cardiac Surgery. PloS one. 2013 Aug 1;8(8). e70360. https://doi.org/10.1371/journal.pone.0070360
Elgharably, Haytham ; Mann, Ethan ; Awad, Hamdy ; Ganesh, Kasturi ; Ghatak, Piya Das ; Gordillo, Gayle ; Sai Sudhakar, Chittoor ; Roy, Sashwati ; Wozniak, Daniel J. ; Sen, Chandan K. / First Evidence of Sternal Wound Biofilm following Cardiac Surgery. In: PloS one. 2013 ; Vol. 8, No. 8.
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