Prevention of early vascular graft infection using regional antibiotic release.
BACKGROUND
Infections after prosthetic replacement of the aorta remain a serious and life-threatening complication. The only appropriate treatment is the surgical removal of the infected prosthesis. Accordingly, there is a need for new procedures to prevent the infection of vascular prostheses. This in vitro experiment investigated the effect of the pretreatment of vascular prostheses with antibiotics (daptomycin or baneocin) and the effect of antibiotics combined with fibrin sealant as possible prophylaxis of perioperative graft infection.


METHODS
Untreated prostheses served as controls. Pretreated prostheses of double woven velour vascular grafts were contaminated with Staphylococcus epidermidis, and colony-forming units were counted each day (CFU/mL).


RESULTS
The period of sterility differed significantly as a function of the pretreatment. Uncoated prostheses were immediately non-sterile and exhibited 2.63 ± 0.61 × 10(5) CFU/mL. Baneocin pretreatment resulted in sterility for 1.7 ± 0.6 (95% confidence interval (CI) 1.0-2.4) d before we detected 2.14 ± 0.57 × 10(5) CFU/mL on the prostheses. Pretreatment with daptomycin yielded 2.9 ± 0.4 (CI 2.6-3.2) and fibrin sealant/baneocin compound yielded 3.1 ± 0.3 (CI 2.9-3.3) d of sterility, after which 1.81 ± 0.86 × 10(5) CFU/mL and 1.04 ± 0.77 × 10(5) CFU/mL were recorded. Finally, pretreatment with fibrin sealant/daptomycin led to sterility for 7.1 ± 0.3 (CI 6.9-7.3) d, after which 0.77 ± 0.60 × 10(5) CFU/mL were observed on the prostheses.


CONCLUSIONS
The risk of vascular graft infection is reduced by pretreating the prostheses with antibiotics. The antibiotic/fibrin compound exhibited an effect of delayed antibiotic release. Vascular prostheses should therefore be pretreated with antibiotic solution to reduce bacterial adhesion. This procedure might be an effective prophylaxis for perioperative vascular graft infection and provides suitable protection for the prosthetic material.
Kuehn
Christian
C
Department of Thoracic, Transplant, and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. kuehn.christian@mh-hannover.de
Graf
Karolin
K
Mashaqi
Bakr
B
Pichlmaier
Maximillian
M
Heuer
Wieland
W
Hilfiker
Andres
A
Stiesch
Meike
M
Chaberny
Iris F
IF
Haverich
Axel
A
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001025:Aortitis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D001414:Bacitracin / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000382:microbiology*; D015169:Colony Count, Microbial; D017576:Daptomycin / Q000627:therapeutic use*; D016503:Drug Delivery Systems / Q000379:methods*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D006801:Humans; D066298:In Vitro Techniques; D009355:Neomycin / Q000627:therapeutic use; D011091:Polyesters; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D013212:Staphylococcus epidermidis
D000900:Anti-Bacterial Agents; D015718:Fibrin Tissue Adhesive; D011091:Polyesters; C020542:velour; D001414:Bacitracin; D009355:Neomycin; D017576:Daptomycin