Study of Bacterial Contamination in the Amniotic Membrane Obtained For Skin Graft

Abstract

Introduction: Limited availability of skin substitute is one of the main factor that hinders optimal management of the burn patients especially those with larger burns. Amniotic membrane is one of the most easily available and cost effective skin substitute but the risk of bacterial infection and disease transmission are present. Therefore, the aim of this study was to investigate bacterial contaminants associated with amniotic membranes and also to monitor our decontamination process for its effectiveness in decreasing bacterial load.

Methods: This study was conducted in Department of Burns, Plastic and Reconstructive Surgery, National Academy of Medical Sciences, Kathmandu. After normal delivery or Cesarean section delivery total 76 placenta (38 each group) were retrieved and amniotic membrane was harvested from it and sent for culture sensitivity (sample 1) then amniotic membrane was washed with normal saline and small tissue from amniotic membrane was sent for culture and sensitivity (sample 2). After normal saline wash further wash was done with Antibiotic mix solution (normal saline 15ml + Inj. Gentamicin 80mg+cefazolin 1gm + Glycerin 85ml ) in a biosafety cabinet class iii chamber (Micro-FiltR India) for 30 minutes. After antibiotic wash amniotic tissue were sent for culture (sample 3).

Results: After use of antibiotics mix solution to wash amniotic membrane marked decreased in bacterial culture was seen in both the groups (36 Cesarean section and 29 vaginal delivery) (p=0.02). Increased bacterial growth was seen in vaginal delivery group with predominance of E. coli but in Cesarean section group, Coagulase negative staphylococcus bacteria were isolated both being sensitive to many drugs like Amikacin, Cefotaxime and Ciprofloxacin.

Conclusion: Bacterial load of amniotic membrane can be reduced by washing with normal saline and antibiotic solution. Due to increased bacterial growth in vaginal delivered amniotic membranes, we suggest only to use amniotic membranes harvested cesarean sections.