title: Graft infectivity of rifampin and silver-bonded polyester grafts to MRSA contamination.
abstract: The purpose of this study was to evaluate the ability of vascular polyester grafts with antibacterial properties to resist colonization following surface contamination by methicillin-resistant Staphylococcus aureus (MRSA) in an experimental canine model or aortic graft infection. Twenty-four pathogen-free dogs underwent replacement of the infrarenal aorta with either a rifampin-soaked (30 mg/mL) or silver-impregnated (Ag-acetate) woven polyester graft. Following implantation, the external graft surface was inoculated with 2 mL of 10(7) colony-forming units/mL (CFU) of MRSA. Preoperative antibiotic prophylaxis consisted of a single intravenous dose of 500 mg of sodium cefazolin. Four grafts of each type were explanted at 3, 7, and 14 days after implantation. Quantitative cultures (CFU/specimen) of perigraft fluid (1 mL), graft material (1 cm segment), and adjacent aorta (1 cm segment) were performed. Differences between grafts are expressed as % mean log reduction in recoverable CFU compared to the inoculation solution concentration of 10(7) CFUs. At 3 days, explanted rifampin-soaked grafts exhibited no MRSA growth (4 of 4 grafts) and a > or =97% mean log reduction of MRSA CFUs from the adjacent aorta and perigraft fluid (PGF). At 3 days, all silver-bonded grafts exhibited signs of infection and a mean log CFU reduction of MRSA ranging from 68% (absolute range 10(1)-10(3) recoverable CFU) for the graft, 79% (absolute range 10(1)-10(3) recoverable CFU) for the aorta, and 86% (absolute range 10(1)-10(4) recoverable CFU) for PGF. The 7-day rifampin group had an average log reduction in MRSA CFU of 72% (graft), 58% (PGF), 75% (aorta). Quantitative cultures of 14-day rifampin grafted demonstrated continued bacterial growth suppression with mean MRSA CFU log reductions of 82%, graft; 72%, PGF; 89%, aorta. Silver-bonded grafts demonstrated <50% mean CFU reduction in MRSA growth at 7 days (absolute range 10(5)-10(7) recoverable CFU) and 14 days (absolute range 10(3)-10(7) recoverable CFU). No animal died from sepsis or anastomotic hemorrhage. Neither rifampin- nor silver-bonded grafts demonstrated prolonged resistance to surface MRSA contamination. Rifampin-soaked polyester grafts exhibited a marked but transient resistance MRSA colonization likely the result of high antibiotic concentration in the perigraft tissue. While both types of grafts failed to eradicate the MRSA infection future research with silver-bonded grafts that have an additional antibiotic attached may have a place in the treatment of MRSA infection.
authors.affiliation: Division of Vascular Surgery, University of South Florida College of Medicine, Tampa, FL 33606, USA.
authors.forename: Dale
authors.initials: D
authors.lastname: Schmacht
authors.forename: Paul
authors.initials: P
authors.lastname: Armstrong
authors.forename: Brad
authors.initials: B
authors.lastname: Johnson
authors.forename: Ketsia
authors.initials: K
authors.lastname: Pierre
authors.forename: Martin
authors.initials: M
authors.lastname: Back
authors.forename: Alan
authors.initials: A
authors.lastname: Honeyman
authors.forename: David
authors.initials: D
authors.lastname: Cuthbertson
authors.forename: Dennis
authors.initials: D
authors.lastname: Bandyk
mesh_terms: D000818:Animals; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D001012:Aorta, Abdominal / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020099:Coated Materials, Biocompatible / Q000494:pharmacology; D004195:Disease Models, Animal; D004285:Dogs; D007083:Iliac Artery / Q000601:surgery; D008297:Male; D016106:Methicillin Resistance / Q000187:drug effects*; D011091:Polyesters / Q000494:pharmacology*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000382:microbiology; D012077:Renal Artery / Q000601:surgery; D012293:Rifampin / Q000494:pharmacology*; D018030:Silver Compounds / Q000494:pharmacology*; D013203:Staphylococcal Infections / Q000209:etiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*
chemical_list: D000904:Antibiotics, Antitubercular; D020099:Coated Materials, Biocompatible; D011091:Polyesters; D018030:Silver Compounds; D012293:Rifampin