Bacteria in implants

[Guest guest]

http://www.geocities.com/HotSprings/8689/saline/s05.html

MICROBIAL GROWTH INSIDE SALINE-FILLED IMPLANTSSource: Plast Reconstr Surg, July, 1997;100(1):182-196 Authors: Young, V. L., Hertl, M. C., Murray, P. R., Jensen, J., Witt, H., Schorr, M.W. Address: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO., USA. Abstract: In vitro and in vivo experiments were conducted to determine whether intraluminal saline in breast implants can support the growth of common wound- infecting microorganisms over a prolonged period of time. The bacteria tested were Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Corynebacterium jeikeium, Enterobacter cloacae, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Three fungal species also were tested: Aspergillus fumigatus, Paecilomyces variofii, and Candida albicans. In the in vitro study, four organisms survived in flasks of sterile saline for the 2 weeks in which serial cultures were performed: K. pneumoniae, C. albicans, A. fumigatus, and P. variotii. In the in vivo study, 61 white rabbits (122 implants) received both an experimental implant inoculated with one of the test organisms and a control implant containing only sterile saline. They were sacrificed at 1-, 3-, or 6-month scheduled endpoints. None of the control implants containing sterile saline had positive cultures. In contrast, the intraluminal saline was culture positive for 7 of the 10 inoculated organisms after varying lengths of time: S. epidermidis, E. coli, E. cloacae, K. pneumoniae, P. aeruginosa, A. fumigatus, and P. variotii. Samples of capsular tissue also were cultured. Of the 122 capsular tissue specimens, 21 (17 percent) had positive cultures and surrounded both inoculated and sterile implants. In most instances, capsules that were culture positive contained an organism different from the one that had been inoculated in the group. In only 3 cases was the same organism cultured from both the periprosthetic tissue and the intraluminal saline, and these may represent instances of the inoculated organism migrating through the implants filler valves. The data show that several types of bacteria (particularly gram-negative species) and fungi can grow and reproduce in a restricted saline environment for extended periods of time.

BACTERIAL GROWTH IN SALINE IMPLANTS; IN VITRO AND IN VIVO STUDIES Author: Chen NT; PE; Hooper DC; May JW Jr Address: Department of Surgery, Massachusetts General Hospital, Boston, 02114. Source: Ann Plast Surg, April, 1996, 36:4, 337-41 Abstract: The survival of bacteria was evaluated in custom-made saline breast implants with integral injection ports in vitro and in 10 New Zealand White rabbits for Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Serratia marcescens. Pseudomonas and Serratia survived in vitro in saline-filled implants and multiplied 24-fold and 22-fold, respectively, from the initial inocula of 300 colony-forming units per cubic centimeter in 21 days. Serratia alone survived in saline implants placed on the dorsum of rabbits, proliferated 80-fold in 7 days, and tapered to 10-fold at the end of 3 weeks. Chemical analysis revealed the presence of glucose in fluid from the implants in the animal study (mean, 1.2 mg per deciliter; standard error of mean [sEM], 0.6) after 21 days and from human subjects (mean, 3.8 mg per deciliter; SEM, 1.0) after 8 months to 10 years. Serratia incubated in human breast implant fluid samples proliferated 7-fold to 30-fold greater than in the saline control in a nonaerated environment. We conclude that some bacteria are able to proliferate in saline in breast implants. Furthermore, their survival may be facilitated by a substance (i.e., glucose) that diffuses across the implant outer shell.

PAECILOMYCES VARIOTII CONTAMINATION IN THE LUMEN OF A SALINE-FILLED BREAST IMPLANT Author: Young VL; Hertl MC; Murray PR; Lambros VS Address: Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Mo., USA. Source: Plast Reconstr Surg, November, 1995, 96:6, 1430-4 Abstract: This report describes a case of gross contamination with the filamentous fungus P. variotii cultured from an intraluminal saline breast implant removed from a patient 14 months after implantation because of severe capsular contracture. We suspect the fungal contamination occurred when a container of saline was left open in the operating room prior to filling and placement of the implant. This case may be the first documented report of microbial growth and reproduction in the internal environment of a saline implant. We assume that organisms such as P. variotii can survive--and accumulate biomass--on the minute amounts of substrates that diffuse across an implant envelope. NOTE: One of the women in our support group brought her intact explanted saline- filled implants to a meeting locally. They are filled with black, brackish saline with particles floating profusely in them. She is also on disability and in a wheelchair. She was a school teacher; another intelligent woman struck down in her 30's or in the prime of life.

DIAGNOSIS AND THERAPY OF SUBCLINICALLY INFECTED PROTHESESAuthors: Parsons CL; Stein PC; Dobke MK; Virden CP; DH Address: Division of Urology, University of California San Diego Medical Center.Source: Surg Gynecol Obstet, Nov., 1993, 177:5, 504-6

Abstract: We believe 5 to 7 percent of prosthetic devices are "subclinically" infected by Staphylococcus epidermidis. These infections are manifested by chronic pain, migration and late extrusion of the devices. To examine this problem, we cultured penile and mammary prostheses. For the experimental arm, we cultured painful penile and mammary prostheses that were being removed because of symptoms (pain). For patients in a control group, we cultured penile prostheses being replaced because of mechanical failure (no pain) and mammary tissue expanders that were temporarily installed. Actual parts of the device were cultured in Trypticase Soy Broth. There were 14 and 12 painful penile and mammary prostheses, 13 and ten, respectively, were cultured positive, for an infection rate of 88 percent. The primary organism identified was S. epidermidis. The nonpainful penile prostheses (zero of five and three of 22 mammary prostheses) grew S. epidermidis. The differences were highly significant (p < 0.001), suggesting that the painful prosthesis is infected. In an attempt to resolve the problem of the painful prosthesis, ten prosthesis were removed and exchanged for new devices. Patients received preoperative and postoperative antibiotics. All ten had positive cultures and nine of ten were successfully exchanged (no pain).

SERRATIA MARCESCENS SURGICAL WOUND INFECTION FOLLOWING BREAST RECONSTRUCTION (WITH SALINE IMPLANTS) Author: Pegues DA; Shireley LA; Riddle CF; RL; Vess RW; Hill BC; Jarvis Address: Hospital Infections Program, Centers for Disease Control, Atlanta, GA Source: Am J Med, September, 1991, 16, 91:3B, 173S-178S Abstract: Surgical wound infections due to gram-negative bacilli have been rarely reported following breast implant surgery. From April to November 1989, four patients from one plastic surgeon's practice developed Serratia marcescens surgical wound infection (SWI) following breast reconstruction procedures with implantation of six expandable mammary implants. All six implants were removed for unabated S. marcescens SWI. Symptoms developed 13-161 days (median, 66 days) after surgery. When compared with nonexpandable silicone breast implants used during the period November 1, 1988, to October 31, 1989, expandable implants were associated with a greater risk of S. marcescens SWI (4/10 versus 0/11 patients, p = 0.04). Epidemiologic studies revealed that infection was associated with saline expansion of the implants performed in the surgeon's office. S. marcescens was cultured from a bag of commercial saline used on at least two of the four patients with SWI; the isolate from the saline and the three available patient isolates had identical serotype (O-undetermined:H4) and antimicrobial susceptibility patterns. Review of office procedures revealed that hands were not routinely washed before and aseptic technique was not used during the expansion procedure. Cultures of unopened bags of saline and an unused expandable implant were sterile. We hypothesize that multiple use of saline bags and nonsterile expansion technique extrinsically contaminated saline solutions and resulted in implant and/or surgical site infection. This investigation underscores the importance of avoiding multiple use of solutions intended for single use and of using aseptic technique when manipulating prosthetic devices

FIBROBLAST BEHAVIOR IN VITRO IS UNALTERED BY PRODUCTS OF STAPHYLOCOCCI CULTURED FROM SILICONE

Author: Dobke MK; Grzybowski J; Stein P; Landon BN; Dobak J; Parsons CLAddress: Division of Plastic Surgery, University of California-San Diego 92103-8890.Source: Ann Plast Surg, February, 1994, 32:2, 118-25

Abstract: Our previous clinical study supported the concept that capsular contracture is associated with subclinical infection of silicone implants. If bacterial presence, indeed, contributes to capsular contracture, then fibroblast behavior might be expected to change in the presence of bacteria byproducts. Therefore, study of possible alteration of fibroblast behavior by bacteria products was undertaken using an in vitro model with cultured dermal fibroblasts. Coagulase-negative staphylococci from silicone mammary and penile implants were isolated and their phenotypic features were characterized. All represented nonbiofilm-producing strains. Products of isolate cultures were noncytotoxic and did not alter matrix reorganization (collagen gel contraction model) or collagen production by fibroblasts. Isolates from either mammary or penile implants exerted similar effects.