Cyanoacrylate gluing increases the effectiveness of systemic antimicrobial treatment in sternal infection: experimental study in a rodent model.
BACKGROUND
Sternal infection is a serious complication of cardiac surgery requiring resternotomy and radical debridement. In this experimental study, we aimed to test our hypothesis that the use of cyanoacrylate gluing (application of an acrylic resin, a monomer of cyanoacrylate molecules, which rapidly polymerizes in the presence of water, forming long, strong chains and joining the bonded surfaces together) together with systemic antimicrobial therapy will provide synergy for the treatment of sternal infection caused by methicillin-resistant Staphylococcus aureus (MRSA).


METHODS
Forty Wistar albino rats were randomly divided into four groups: Group I, uncontaminated sham group; Group II, untreated contaminated control group; Group III, contaminated group receiving only systemic vancomycin therapy; Group IV, contaminated group treated with a combination of cyanoacrylate gluing and systemic vancomycin. Cyanoacrylate gluing was applied on the 3rd postoperative day and all rats alive at the end of 8th week were sacrificed. The degree of sternal infection was assessed histologically and also by quantitative culture analysis.


RESULTS
Histological evaluation revealed that cyanoacrylate was degraded and replaced by connective tissue at the end of the 8th week. Culture analysis revealed that the average growth of microorganisms was significantly reduced in Groups III and IV. In Group IV, the reduction in the amount of growing microorganisms was found to be more pronounced and significantly lower than in Groups II and III.


CONCLUSIONS
Our experimental model suggests that cyanoacrylate gluing provides significant synergy for systemic antimicrobial therapy. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of mediastinitis and sternal osteomyelitis in rats.
Basaran
M
M
Goztepe Safak Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey. dr_murat_basaran@yahoo.com
Kafali
E
E
Ugurlucan
M
M
Kalko
Y
Y
Selimoglu
O
O
Us
M H
MH
Ogus
T N
TN
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001843:Bone Cements / Q000378:metabolism / Q000627:therapeutic use*; D003487:Cyanoacrylates / Q000378:metabolism / Q000627:therapeutic use*; D004195:Disease Models, Animal; D005260:Female; D008297:Male; D016106:Methicillin Resistance; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013249:Sternum / Q000382:microbiology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D003487:Cyanoacrylates; D014640:Vancomycin