Surgical are caused by Staphylococcus aureus, Enterobacteria species and

Surgical Site
Infections(SSIs) have been defined as the infections that occur within 30 days
of surgery ( or withina ayear for implants) and affect  the site of incision  or deep tissues .2 SSIs are caused by Staphylococcus aureus, Enterobacteria species and also E. coli.13 SSIs have been found in
approximately 20% of patients who  have undergone
a surgical procedure .3 Existence of efflux pump (EP) has been shown to be  one  of
the most important mechanisms  of  antibiotic resistance in bacteria4 In a
situation, where this is the sole mechanism of 
resistance shown by an isolate,  for a particular drug , the possibility of use
of  EP inhibitor might be rewarding. Evaluation
of  the extent to which EP  is responsible for fluoroquinolone(FQ)
resistance would generate the required data as background information for
contemplating combined use EP inhibitor  and
FQs, at least topically in Surgical Site Infections, in view  of 
dwindling  options of
antimicrobial therapy due to emerging wide spread resistance.5

           

E. coli  is one of the major bacteria  responsible for Surgical Site Infections 3
.Multi drug resistance , including to FQs, in E. coli are being reported from different quarters across the globe9
.The emerging phenomenon has pushed the surgeons to depend on fourth
generation cephalosporins8, which 
might be rendered ineffective before long  by spread of ‘New Delhi Beta Lactamase’ gene
in hospitals10.

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FQs, both oral and
parenteral antibacterial agents, are found to be effective against gram
negative rods 7 . FQ resistance is due to mutation of genetic code for DNA gyrase
. and presence of EP preventing achievement of cytoplasmic concentration for
bactericidal action 6.Therefore EP inhibitors (EPI) have a role to play for
making FQs more effective, at least against a group of resistant bacteria,
where instead of mutation of DNA gyrase, EP is the sole mechanism of resistance

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