title: Prevention of graft infection by bonding of gentamycin to Dacron prostheses.
abstract: To increase the efficacy of perioperative antibiotic prophylaxis in vascular surgery an experimental study including topical application of the gentamicin derivative EMD 46/217 and fibrin sealant as antibiotic carrier to Dacron prostheses was initiated. In vitro treatment of Dacron with gentamicin and fibrin was followed by constant antibiotic release for 3 weeks. In a subsequent animal study Dacron grafts were implanted in the aorta of 10 pigs after direct contamination with Staphylococcus aureus solution. One graft was pretreated with the antibiotic/fibrin compound, a second with the antibiotic alone. Grafts 3 (no pretreatment) and 4 (fibrin alone) served as controls. After 1 week the grafts and their corresponding implantation sites were excised for measurement of antibiotic content and for culture. The antibiotic content of grafts with the antibiotic/fibrin compound was 25.0 +/- 7.2 micrograms/gm wet weight, whereas Dacron pretreated with the antibiotic alone contained no measurable drug amounts except for one specimen (0.5 microgram/gm) (antibiotic/fibrin vs antibiotic, p less than .0005). The corresponding implantation sites to antibiotic/fibrin grafts contained 1.07 +/- 0.54 microgram/gm antibiotic, whereas in only 2/10 implantation sites of antibiotic grafts low antibiotic levels were found (0.05 and 0.2 microgram/gm) (antibiotic/fibrin vs antibiotic, p less than 0.005). All control grafts and 9/10 antibiotic grafts were infected. By contrast, only five were contaminated, and 5 of 10 remained sterile after culture (antibiotic/fibrin vs antibiotic, p less than 0.05). This finding correlates with the antibiotic content in the Dacron. It is concluded that pretreatment of prosthetic Dacron grafts with the antibiotic/fibrin compound results in binding of sufficient amounts of antibiotic for at least 1 week.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: S
authors.initials: S
authors.lastname: Hirt
authors.forename: M
authors.initials: M
authors.lastname: Karck
authors.forename: F
authors.initials: F
authors.lastname: Siclari
authors.forename: H
authors.initials: H
authors.lastname: Wahlig
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001412:Bacillus subtilis / Q000187:drug effects; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D015718:Fibrin Tissue Adhesive; D005839:Gentamicins / Q000627:therapeutic use*; D008826:Microbial Sensitivity Tests; D011093:Polyethylene Terephthalates; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000517:prevention & control; D013552:Swine
chemical_list: D015718:Fibrin Tissue Adhesive; D005839:Gentamicins; D011093:Polyethylene Terephthalates