title: Treatment of established prosthetic vascular graft infection with antibiotics preferentially concentrated in leukocytes.
abstract: The efficacy of treating established vascular graft infections with rifampin and clindamycin (preferentially concentrated in leukocytes) and cefazolin (not concentrated in leukocytes) was studied in a canine model. Infrarenal aortic, 6 mm by 6 cm knitted Dacron double velour grafts were implanted and infected with 10(8) colony-forming units (CFU) of coagulase-positive Staphyloccus aureus organisms injected intravenously immediately after graft placement. Antibiotic therapy was instituted at 3 months postimplantation. Three groups were studied: (I) untreated controls (n = 3); (II) therapy with intravenous cefazolin 15 mg/kg/8 hr for 28 days (n = 7); and (III) combined therapy with intravenous rifampin 13 mg/kg/24 hr and intravenous clindamycin 13 mg/kg/8 hr for 28 days (n = 7). Grafts were removed for quantitative bacteriologic studies after the 28-day course of therapy. Two group I control grafts remained patent with 6.4 X 10(6) and 8.1 X 10(3) CFU S. aureus/gm of graft. The third control graft was thrombosed. Two group II animals demonstrated 1.6 X 10(7) and 2.3 X 10(5) CFU S. aureus organisms/gram of graft, respectively; the remaining five group II grafts were free of organisms. All group III grafts were sterile--a significant difference (p less than 0.05) from group I grafts. In this experimental model, established prosthetic graft infections were eradicated by intensive treatment with antibiotics preferentially concentrated in leukocytes.
mesh_terms: D000818:Animals; D001807:Blood Vessel Prosthesis; D002437:Cefazolin / Q000378:metabolism / Q000627:therapeutic use; D002981:Clindamycin / Q000378:metabolism / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004285:Dogs; D004359:Drug Therapy, Combination; D005260:Female; D007962:Leukocytes / Q000378:metabolism*; D012293:Rifampin / Q000378:metabolism / Q000627:therapeutic use*; D013203:Staphylococcal Infections / Q000188:drug therapy; D013530:Surgical Wound Infection / Q000188:drug therapy*
chemical_list: D002981:Clindamycin; D002437:Cefazolin; D012293:Rifampin