The prophylactic efficacy of rifampicin-soaked graft in combination with systemic vancomycin in the prevention of prosthetic vascular graft infection: an experimental study.
OBJECTIVE
To investigate the prophylactic efficacy of systemic, topical, or combined antibiotic usage in the prevention of late prosthetic vascular graft infection caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and the differential adherence of S. epidermidis to Dacron and ePTFE grafts in a rat model.


METHODS
Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm(2) Dacron/ePTFE prosthesis followed by topical inoculation with 2 x 10(7) CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture.


RESULTS
MRSE had significantly greater adherence to Dacron than ePTFE grafts in the untreated contaminated groups (P < 0.001). Rifampicin had better efficacy than vancomycin in topical application, but the difference was not statistically significant (P > 0.05). Intraperitoneal vancomycin showed a significantly higher efficacy than topical vancomycin or rifampicin (P < 0.001). The best results were provided by a combination of intraperitoneal vancomycin in rifampicin-soaked graft groups (P < 0.001).


CONCLUSIONS
The combination of rifampicin and intraperitoneal vancomycin seems to be the best choice for the prophylaxis of late prosthetic vascular graft infections caused by MRSE.
Sacar
Mustafa
M
Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey. mustafasacar@hotmail.com
Goksin
Ibrahim
I
Baltalarli
Ahmet
A
Turgut
Huseyin
H
Sacar
Suzan
S
Onem
Gokhan
G
Ozcan
Vefa
V
Adali
Fahri
F
D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000904:Antibiotics, Antitubercular / Q000494:pharmacology*; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D019917:Blood Vessel Prosthesis Implantation; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D008297:Male; D016106:Methicillin Resistance; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D051381:Rats; D017208:Rats, Wistar; D012293:Rifampin / Q000494:pharmacology*; D013203:Staphylococcal Infections / Q000517:prevention & control*; D013212:Staphylococcus epidermidis / Q000187:drug effects* / Q000254:growth & development; D014640:Vancomycin / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D011093:Polyethylene Terephthalates; D014640:Vancomycin; D011138:Polytetrafluoroethylene; D012293:Rifampin