Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin.
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.
Sakaguchi
Hisashi
H
Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Marui
Akira
A
Hirose
Keiichi
K
Nomura
Takamasa
T
Arai
Yoshio
Y
Bir
Shyamal Chandra
SC
Huang
Yuhong
Y
Esaki
Jiro
J
Tabata
Yasuhiko
Y
Ikeda
Tadashi
T
Komeda
Masashi
M
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*
D000900:Anti-Bacterial Agents; D002208:Caproates; D003692:Delayed-Action Preparations; D007783:Lactones; D011091:Polyesters; C033616:poly(lactide); C121056:caprolactone; D014640:Vancomycin