Journal article
Can Methicillin-resistant Staphylococcus aureus Silently Travel From the Gut to the Wound and Cause Postoperative Infection? Modeling the "Trojan Horse Hypothesis"
Annals of surgery, Vol.267(4), pp.749-758
04/01/2018
DOI: 10.1097/SLA.0000000000002173
PMID: 28187042
Abstract
Objective: To determine whether intestinal colonization with methicillin-resistant Staphylococcus aureus (MRSA) can be the source of surgical site infections (SSIs).
Background: We hypothesized that gut-derived MRSA may cause SSIs via mechanisms in which circulating immune cells scavenge MRSA from the gut, home to surgical wounds, and cause infection (Trojan Horse Hypothesis).
Methods: MRSA gut colonization was achieved by disrupting the microbiota with antibiotics, imposing a period of starvation and introducing MRSA via gavage. Next, mice were subjected to a surgical injury (30% hepatectomy) and rectus muscle injury and ischemia before skin closure. All wounds were cultured before skin closure. To control for postoperative wound contamination, reiterative experiments were performed in mice in which the closed wound was painted with live MRSA for 2 consecutive postoperative days. To rule out extracellular bacteremia as a cause of wound infection, MRSA was injected intravenously in mice subjected to rectus muscle ischemia and injury.
Results: All wound cultures were negative before skin closure, ruling out intraoperative contamination. Out of 40 mice, 4 (10%) developed visible abscesses. Nine mice (22.5%) had MRSA positive cultures of the rectus muscle without visible abscesses. No SSIs were observed in mice injected intravenously with MRSA. Wounds painted with MRSA after closure did not develop infections. Circulating neutrophils from mice captured by flow cytometry demonstrated MRSA in their cytoplasm.
Conclusions: Immune cells as Trojan horses carrying gut-derived MRSA may be a plausible mechanism of SSIs in the absence of direct contamination.
Details
- Title: Subtitle
- Can Methicillin-resistant Staphylococcus aureus Silently Travel From the Gut to the Wound and Cause Postoperative Infection? Modeling the "Trojan Horse Hypothesis"
- Creators
- Monika A. Krezalek - University of ChicagoSanjiv Hyoju - University of ChicagoAlexander Zaborin - University of ChicagoEmeka Okafor - University of ChicagoLaxmi Chandrasekar - University of ChicagoVitas Bindokas - University of ChicagoKristina Guyton - University of ChicagoChristopher P. Montgomery - University of ChicagoRobert S. Daum - University of ChicagoOlga Zaborina - University of ChicagoSusan Boyle-Vavra - University of ChicagoJohn C. Alverdy - University of Chicago
- Resource Type
- Journal article
- Publication Details
- Annals of surgery, Vol.267(4), pp.749-758
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/SLA.0000000000002173
- PMID
- 28187042
- ISSN
- 0003-4932
- eISSN
- 1528-1140
- Number of pages
- 10
- Grant note
- 5R01GM062344-15 / NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA University of Chicago CTSA-ITM Core Subsidies Grant 2015 R01GM062344 / NATIONAL INSTITUTE OF GENERAL MEDICAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of General Medical Sciences (NIGMS)
- Language
- English
- Date published
- 04/01/2018
- Academic Unit
- Surgery
- Record Identifier
- 9984322796002771
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