A narrative review of microbial biofilm in postoperative surgical site infections: clinical presentation and treatment

Edmiston, Charles E., McBain, Andrew, Kiernan, Martin and Leaper, David (2016) A narrative review of microbial biofilm in postoperative surgical site infections: clinical presentation and treatment. Journal of Wound Care, 25 (12). pp. 693-702. ISSN 0969-0700

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Edmiston et al Final BJS Biofilm Review Submission July 14 - 2016 (1).docx - Accepted Version

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Abstract

Objective: The global impact of surgical site infections (SSIs) on healthcare systems is considerable: many are related to the formation of a microbial biofilm. Biofilm plays a significant role in the pathogenesis of implantable device-related infections and are also important in persistent postoperative skin and soft tissue wound infections.

Method: PubMed and OVID databases were searched for relevant
articles regarding biofilm-associated infection in surgery, including epidemiology, diagnosis, treatment and management.

Results: Biofilm-associated infections increase the use of health-care resources, prolong length of stay, increase cost of antibiotic therapy, result in additional surgical revisions and extend rehabilitation after discharge from health care. Staphylococcus aureus and Staphylococcus epidermidis are the most common isolates recovered from device-related infections. Early infection occurs within two weeks of implantation and is associated with intraoperative wound contamination; late-onset infections
are often occult prolonging recognition by weeks, months and in some cases, years. Biofilm is a physical barrier against antibodies and granulocytic cell populations which may also impede the penetration of antibiotics. The ideal strategy for preventing biofilm-associated SSI is to prevent intraoperative contamination through compliance with effective surgical care bundles. Management of postoperative biofilm-associated infections involves surgical debridement followed by irrigation with antimicrobial agents and removal of infected devices, followed by insertion of antimicrobial adjuncts such as antimicrobial spacers, beads or sutures together with selective therapeutic agents that penetrate the mature biofilm.

Conclusion: Biofilm-associated infections are a significant source of postoperative morbidity and mortality. Appropriate interventional strategies are warranted to reduce the risk of intraoperative contamination

Item Type: Article
Additional Information: This document is the Accepted Manuscript version of a Published Work that appeared in final form in Journal of Wound Care, © MA Healthcare 2016, after peer review and technical editing by the publisher. To access the final edited and published work see: https://doi.org/10.12968/jowc.2016.25.12.693
Uncontrolled Keywords: Biofilm, Surgical wound infection
Subjects: Medicine and health > Microbiology
Medicine and health > Nursing > Nursing practice
Medicine and health > Clinical medicine > Clinical care
Medicine and health > Physiology
Depositing User: Martin Kiernan
Date Deposited: 04 Jan 2017 10:46
Last Modified: 25 May 2017 14:44
URI: http://repository.uwl.ac.uk/id/eprint/3017

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