Demographic characteristics of patients (n = 9) and SWI status.

<p>M, male, F, female; AKI, acute kidney disease; BMI, body mass index, CAD, coronary artery disease; CGH, coronary heart disease; DM, diabetes mellitus; END, endocarditis; GERD, gastro esophageal reflux disease; HTN, hypertension; HTN- P, Pulmonary hypertension; HLD, hyperlipidemia; RD, renal dysfunction; COPD, chronic obstructive pulmonary disease; PVD, peripheral vascular disease; OSA, obstructive sleep apnea; RHD, rheumatic heart disease; CABG, coronary artery bypass graft; MVR, mitral valve replacement; LVAD, left ventricular assisted device; PM, pace maker; RV, right ventricle; N, negative; MSSA, Methicillin-sensitive <i>Staphylococcus aureus</i>; MRSA, Methicillin-resistant <i>Staphylococcus aureus;</i> SVT, supraventricular tachycardia.</p

Presence of staphylococci within the infected debrided wound tissues.

<p>Representative confocal microscopy images of debrided tissue using immunofluorescence staining (debrided tissues was counterstained red with Phalloidin). Note large aggregates of staphylococci (intense green granular stain) colonizing the debrided tissues of infected sternal wound (lower panels), while tissues taken from a non-infected sternal wound during resternotomy (upper panels) show no colonization with staphylococci. Scale bar = 50 µm, 400x magnification. (SWI: sternal wound infection). Right panel is the zoom of the dashed boxed area in the left panel (scale bar = 20 µm).</p

MRSA Strain USA300 biofilm exhibits enhanced tolerance to tobramycin when grown as a biofilm on surgical wires.

<p>USA300 was used to inoculate in vitro wells containing sections of wire. Planktonic bacteria and wire-associated biofilms were challenged with 10 ug/ml of tobramycin for 2 hours. Bacteria tolerant to antibiotic challenge were enumerated using viability plating and compared to untreated parallel controls. Percent survivability of triplicate cultures is represented. nd, not detected, ns, not significant. Data are mean±SD (n = 3), *p<0.05 compared to untreated planktonic (Mann Whitney test).</p

Digital photos and gram staining of deep sternal wound infection in two patients scheduled for a debridement procedure.

<p>(A) Digital photos of the infected sternal wounds. Note the signs of active infection with localized erythema, exudates, friable wound edges and sternal instability. Sternal wires were removed before the debridement procedure. (B) Gram-Twort staining of debrided tissues taken of infected sternal wound showing clumps of Gram-positive cocci (arrows in right panel). Left panel, scale bar = 50 µm, 400x magnification. Right panel is the zoom of the dashed boxed area in the left panel (scale bar = 50 µm).</p

Confocal laser scanning microscopy images showing three dimensional presence of staphylococci in infected debrided wound tissue.

<p>Z-stack image created by merging serial scans of thick tissue section (20 µm), viewed under 600x magnification confocal laser scanning microscopy. Showing in the <i>x/y</i> plane clumps of staphylococci colonizing the debrided tissues (red), while the <i>x/z</i> and <i>y/z</i> planes display the depth of the colonization throughout the tissue section. Three-dimensional orthogonal projections of z-stack image in panel (oriented in two different planes) showing of staphylococci aggregates biomass within the debrided tissues.</p

Scanning electron microscopy images of infected stainless steel wires used for sternotomy closure.

<p>(A) Left panel is a SEM at 60x magnification of an unused sterile stainless steel wire, twisted in a way similar to that after sternotomy closure. Scale bar = 1 mm. Right panel is a higher magnification (10,000x) of the dashed box area in the left panel, showing the metal surface of the wire. Scale bar = 5 µm (B) Left panel is a SEM at 60x magnification of stainless steel wire after overnight incubation with MRSA strain USA300. Scale bar = 1 mm. Note the wire metal surface is coated by a film of material. Right panel is a higher magnification (10,000x) of the dashed box area in the left panel, showing clusters of cocci attached to the extracted wire and embedded within amorphous slime. Scale bar = 5 µm.</p