Inguinal microbiome in patients undergoing an endovascular aneurysm repair: Application of next-generation sequencing of the 16S-23S rRNA regions

B P Vierhout; A Ott; I Kruithof; G Wisselink; E van Zanten; A M D Kooistra-Smid; C J Zeebregts; R A Pol

doi:10.1016/j.mehy.2019.109358

Inguinal microbiome in patients undergoing an endovascular aneurysm repair: Application of next-generation sequencing of the 16S-23S rRNA regions

Med Hypotheses. 2019 Nov:132:109358. doi: 10.1016/j.mehy.2019.109358. Epub 2019 Aug 10.

Authors

B P Vierhout¹, A Ott², I Kruithof³, G Wisselink², E van Zanten², A M D Kooistra-Smid⁴, C J Zeebregts⁵, R A Pol⁶

Affiliations

¹ Department of Surgery, Wilhelmina Hospital, Assen, The Netherlands. Electronic address: Bas.Vierhout@WZA.NL.
² Certe, Department of Medical Microbiology, Groningen, The Netherlands.
³ Department of Pathology, Martini Hospital, Groningen, The Netherlands.
⁴ Certe, Department of Medical Microbiology, Groningen, The Netherlands; Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁵ Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁶ Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

PMID: 31437669
DOI: 10.1016/j.mehy.2019.109358

Abstract

Background: Surgical site infection (SSI) remains a hazardous complication after vascular surgery. In this pilot study we investigated the inguinal microbiome in skin biopsies using histology and 16S-23S rDNA Next Generation Sequencing (NGS). Our hypothesis was that causative microorganisms of SSI are present in the inguinal microbiome.

Methods: Data on surgical site infections and skin samples from the Percutaneous in Endovascular Repair versus Open (PiERO) trail were evaluated. Two patients with SSI were matched for age and comorbidity to eight matching patients of the PiERO trial. All patients were treated for an abdominal aortic aneurysm with endovascular repair. Nasal and perineal cultures were taken preoperatively to detect Staphylococcus aureus carriage. After disinfection with chlorhexidine, groin biopsies were taken to identify bacteria in deeper skin layers. All samples were subjected to histological analysis and culture-free 16S-23S rDNA NGS.

Results: Staphylococcus aureus species were cultured in 5 out of 20 preoperative nasal and perineal swaps. Histology detected only a few bacteria. NGS of the 16S-23S rRNA regions identified DNA of bacterial species in all biopsies (20/20). Most identified genera and species proved to be known skin flora bacteria. No relation was found between SSIs and the preoperative microbiome.

Conclusion: In this pilot study, an innovative analysis of the preoperative microbiome using 16S-23S rDNA NGS did not show a relation with the occurrence of a surgical site infection. No pathogenic bacterial species were present in the inguinal skin after disinfection with chlorhexidine.

Keywords: Bacteria; Endovascular surgery; Next-generation sequencing; Skin; Surgical wound infection.

Publication types

Multicenter Study
Randomized Controlled Trial

MeSH terms

Aged
Anti-Bacterial Agents / pharmacology
Aortic Aneurysm, Abdominal / microbiology*
Aortic Aneurysm, Abdominal / surgery*
Biopsy
Chlorhexidine / pharmacology
Comorbidity
Groin / pathology
High-Throughput Nucleotide Sequencing*
Humans
Male
Microbiota / genetics*
Pilot Projects
RNA, Ribosomal, 16S / genetics
RNA, Ribosomal, 23S / genetics
Staphylococcus aureus
Surgical Wound Infection / microbiology*
Surgical Wound Infection / pathology*
Surgical Wound Infection / prevention & control

Substances

Anti-Bacterial Agents
RNA, Ribosomal, 16S
RNA, Ribosomal, 23S
Chlorhexidine