title: Chronic surgical site infection due to suture-associated polymicrobial biofilm.
abstract: BACKGROUND
  Surgical site infection (SSI) is a common surgical complication; culture-negative SSI presents a particular problem in management.
  
  
  METHODS
  Examination of explanted foreign bodies (sutures) using confocal laser scanning microscopy (CLSM) and fluorescent in situ hybridization (FISH) after surgical exploration of a chronic culture-negative SSI.
  
  
  RESULTS
  Confocal microscopy (CM) demonstrated bacilli and cocci attached to the surface of the explanted sutures in a mixed biofilm. Fluorescent in situ hybridization confirmed that Staphylococci were components of the mixed biofilm. Removal of the foreign bodies (sutures) resolved the chronic infection.
  
  
  CONCLUSIONS
  Chronic SSI can arise from underlying bacterial biofilms, which can invest implanted foreign bodies and associated soft tissue surfaces.
authors.affiliation: Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA. skathju@wpahs.org
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kathju
authors.forename: Laura
authors.initials: L
authors.lastname: Nistico
authors.forename: Luanne
authors.initials: L
authors.lastname: Hall-Stoodley
authors.forename: J Christopher
authors.initials: JC
authors.lastname: Post
authors.forename: Garth D
authors.initials: GD
authors.lastname: Ehrlich
authors.forename: Paul
authors.initials: P
authors.lastname: Stoodley
mesh_terms: D000328:Adult; D018441:Biofilms / Q000254:growth & development*; D002908:Chronic Disease; D003352:Corynebacterium / Q000302:isolation & purification*; D003354:Corynebacterium Infections / Q000382:microbiology; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D018613:Microscopy, Confocal; D013203:Staphylococcal Infections / Q000382:microbiology; D013210:Staphylococcus / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000382:microbiology*; D013537:Sutures / Q000382:microbiology*