Efficacy of collagen silver-coated polyester and rifampin-soaked vascular grafts to resist infection from MRSA and Escherichia coli in a dog model.
The primary objective of this study was to compare the efficacy of a collagen silver-coated polyester graft, InterGard, with a gelatin-sealed graft, Gelsoft, both soaked in rifampin, for resistance to direct bacterial contamination in an animal model. The second objective was to confirm the lack of inflammation from silver acetate. Vascular grafts, 6 mm in diameter, were implanted in the infrarenal aorta of 28 dogs. Intravenous cefamandole (20 mg/kg) was injected intraoperatively in all dogs. The dogs were divided into three groups. Group I included 12 dogs. Six dogs received silver grafts and six dogs received gelatin-sealed grafts, all soaked with rifampin. Grafts implanted in group I were directly infected with methicillin-resistant Staphylococcus aureus (MRSA). Group II included also six silver grafts and six gelatin-sealed grafts, all soaked with rifampin. Dogs of group II were directly infected with Escherichia coli. Group III comprised four dogs, which received gelatin unsealed grafts, directly infected with MRSA, the control group. All dogs were followed by regular clinical examination, including blood cultures. Grafts in groups I and III and in group II were harvested at 30 days and 10 days, respectively. Bacterial analyses were performed on the explanted grafts. Histology was performed on both the tissue samples and the anastomotic sites of the harvested grafts. In group I, no grafts were infected with MRSA, irrespective of graft type. In group II, no silver grafts were infected with E. coli, whereas one (16.6%) of six gelatin-sealed grafts was infected (p = 0.317). In group III, three (75%) of the four grafts were infected with MRSA. The infection rate in the silver grafts and the gelatin-sealed grafts soaked in rifampin in group I compared with the unsealed gelatin grafts in group III was statistically significantly different (p < 0.05). There was no statistically significant difference in the inflammation score, obtained by histological analysis, between rifampin-soaked silver and Gelsoft grafts in either group I or group II. There were signs of necrosis at the anastomoses in three (25%) gelsoft grafts of 12 in groups I and II. There were no clinical or biological signs of inflammation from use of silver-coated grafts. These results indicate that collagen silver-coated grafts and gelatin-sealed grafts, both soaked in rifampin, provide resistance against MRSA and E. coli. There was a trend toward better resistance but without statistical significance against E. coli from the rifampin silver graft compared with the rifampin-soaked Gelsoft graft, without signs of inflammation from InterGard silver grafts.
Schneider
Fabrice
F
Vascular Surgery, Hospital Henri Mondor, Créteil, France.
O'Connor
Stephen
S
Becquemin
Jean Pierre
JP
D000085:Acetates / Q000008:administration & dosage / Q000009:adverse effects; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001011:Aorta / Q000382:microbiology / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003094:Collagen; D004195:Disease Models, Animal; D004285:Dogs; D004926:Escherichia coli / Q000472:pathogenicity*; D004927:Escherichia coli Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D005780:Gelatin; D007249:Inflammation / Q000139:chemically induced; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity*; D011091:Polyesters; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D012293:Rifampin / Q000008:administration & dosage; D018030:Silver Compounds / Q000008:administration & dosage / Q000009:adverse effects; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D013997:Time Factors
D000085:Acetates; D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D011091:Polyesters; D018030:Silver Compounds; C103100:silver acetate; D005780:Gelatin; D003094:Collagen; D012293:Rifampin