The acute phase response following implantation of triclosan-bonded vascular prostheses.
OBJECTIVE
Infection of prosthetic material is a major complication of vascular surgery. Therapy for it includes implantation of antimicrobial prostheses bonded with different antimicrobial agents. These agents may, however, induce an acute phase reaction following implantation in the host, thus compromising follow-up of the infection. It is not known whether the antimicrobial agent triclosan induces a significant acute phase reaction when bonded to vascular prostheses.


METHODS
To study this, 34 adult swine weighing 20-30 kg were allotted randomly to the following groups: (1) controls with untreated prostheses, (2) control group with triclosan-bonded prostheses, (3) therapy group with untreated prostheses, local infection with Staphylococcus aureus surgical revision, and exchange with new, untreated prostheses, and (4) therapy group with untreated prostheses, local infection with S. aureus, surgical revision, and exchange with triclosan-bonded prostheses. Serum C-reactive protein (CRP) and haptoglobin values were determined during the 28-day period after surgery. The study was performed at the Institute for Surgical Research of the Ludwig Maximilian University School of Medicine in Munich.


RESULTS
Normal ranges of serum CRP and haptoglobin values were 10.7+/-1.4 microg/ml and 2.5+/-0.3 mg/ml, respectively. Following implantation of untreated and triclosan-bonded vascular prostheses, significantly elevated serum CRP and haptoglobin values were observed. No significant differences between results with triclosan-bonded and untreated prostheses were observed in control or treatment groups. No correlation was found between acute phase reaction and the absence or presence of infection.


CONCLUSIONS
Triclosan is the only antimicrobial agent that bonds to vascular prosthetic material without the need of a sealant. Our data indicate that vascular prosthesis implantation, whether untreated and triclosan-bonded, results in a significant acute phase reaction. No differences between antimicrobial and untreated prostheses were observed, independently of the absence or presence of infection. The antimicrobial agent itself did not induce a severe acute phase response and may, therefore, be used in patients at risk of infection.
Hernandez-Richter
T M
TM
Department of Surgery, Ludwig Maximilian University, Klinikum Grosshadern, Munich, Germany. Christ.Hopf@gch.med.uni-muenchen.de
Wichmann
M W
MW
Schrödl
W
W
Angele
M K
MK
Heinritzi
K
K
Schildberg
F W
FW
D000209:Acute-Phase Proteins / Q000378:metabolism*; D000704:Analysis of Variance; D000818:Animals; D000891:Anti-Infective Agents, Local; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D002097:C-Reactive Protein / Q000378:metabolism; D004867:Equipment Design; D006242:Haptoglobins / Q000378:metabolism; D011183:Postoperative Complications / Q000517:prevention & control; D012086:Reoperation; D013203:Staphylococcal Infections / Q000503:physiopathology* / Q000517:prevention & control; D013211:Staphylococcus aureus; D013552:Swine; D013997:Time Factors; D014260:Triclosan / Q000494:pharmacology*
D000209:Acute-Phase Proteins; D000891:Anti-Infective Agents, Local; D006242:Haptoglobins; D014260:Triclosan; D002097:C-Reactive Protein