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Surgical Site
Infections (SSIs) have been defined as the infections that occur within 30 days
of  a surgery ( or within one year for
implants) and affect  the site of
incision  or tissues deep to it .2 SSIs
are caused by Staphylococcus aureus, Enterobacteria species and also E. coli.13 SSIs have developed in
approximately 20% of patients who  have gone
through a surgical procedure .3 Presence of efflux pumps (EPs) 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 resistance
to fluoroquinolones(FQs) can provide researchers with 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 has been reported from different quarters across the world9
.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  has
been shown to be caused by mutation of genetic code for DNA gyrase and also by
the 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

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