title: Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin.
abstract: OBJECTIVE
  Methicillin-resistant Staphylococcus aureus graft infection is one of the most serious complications of vascular surgery. Vancomycin is a potent antibiotic against methicillin-resistant S. aureus; however, systemic administration of vancomycin is not very effective against methicillin-resistant S. aureus graft infection. Therefore, we investigated whether a local sustained release of vancomycin prevents methicillin-resistant S. aureus graft infection.
  
  
  METHODS
  We have developed a poly-L-lactide-co-caprolactone sheet that enabled sustained release of vancomycin for 2 weeks. An expanded polytetrafluoroethylene vascular graft patch (1.5 mm2) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S. aureus (1.0 x 10(3) colony-forming units) was inoculated onto the graft surface. Thereafter, the graft was treated as follows (n = 6 each): no treatment (control group), local injection of an aqueous solution of vancomycin (vancomycin solution group) and local implantation of poly-L-lactide-co-caprolactone containing vancomycin (vancomycin-PLCA group). After 7 days, the graft and blood were sampled and cultured.
  
  
  RESULTS
  The methicillin-resistant S. aureus counts in the grafts of the vancomycin-PLCA group were significantly lower than those of the other groups. Blood cultures of the vancomycin-PLCA group were all negative, whereas those of the other groups were all positive for infection. The survival rate in the vancomycin-PLCA group at 28 days was considerably higher than that in the control group (83.3% vs 16.7%).
  
  
  CONCLUSIONS
  A local sustained-release sheet containing vancomycin reduced methicillin-resistant S. aureus counts in the infected vascular grafts, prevented sepsis, and drastically improved survival rates. This can be used as a highly effective and less-invasive adjunctive treatment method for preventing prosthetic methicillin-resistant S. aureus graft infection.
authors.affiliation: Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Marui
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hirose
authors.forename: Takamasa
authors.initials: T
authors.lastname: Nomura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Arai
authors.forename: Shyamal Chandra
authors.initials: SC
authors.lastname: Bir
authors.forename: Yuhong
authors.initials: Y
authors.lastname: Huang
authors.forename: Jiro
authors.initials: J
authors.lastname: Esaki
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tabata
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ikeda
authors.forename: Masashi
authors.initials: M
authors.lastname: Komeda
mesh_terms: D020341:Absorbable Implants; D000287:Administration, Topical; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002208:Caproates; D003692:Delayed-Action Preparations; D004195:Disease Models, Animal; D016503:Drug Delivery Systems; D007783:Lactones; D008297:Male; D016106:Methicillin Resistance; D011091:Polyesters; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D051381:Rats; D017208:Rats, Wistar; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D002208:Caproates; D003692:Delayed-Action Preparations; D007783:Lactones; D011091:Polyesters; C033616:poly(lactide); C121056:caprolactone; D014640:Vancomycin