title: Cefotaxime-eluting covered self-expandable stents in a canine biliary model: scanning electron microscopic study of biofilm formation.
abstract: BACKGROUND
  As bacterial attachment and subsequent biofilm formation on the surface of a stent lumen may be important in initiating sludge formation and subsequent stent blockage, there is a need for antibiotic-eluting stents to prevent sludge formation by bacterial attachment and colonization.
  
  
  OBJECTIVE
  To evaluate the antimicrobial effects of cefotaxime-eluting covered self-expandable stents (CE-CSEMS) in a canine biliary model by using scanning electron microscopy (SEM) to analyze biofilm formation on the inner surface of the stents.
  
  
  METHODS
  Three 10% (wt/vol) CE-CSEMS, three 20% (wt/vol) CE-CSEMS, and three control stents (CS) were endoscopically inserted into the bile ducts of nine mongrel dogs, which were followed up for 8 weeks. Gross and SEM examinations were performed to access the development and degree of biofilm formation in dogs with CS and CE-CSEMS.
  
  
  RESULTS
  All stents were successfully inserted into canine bile ducts without any procedure-related complications. All nine dogs remained in good health without jaundice over the next 8 weeks. The degree of biofilm was similar in dogs implanted with CS and CE-CSEMS using two concentrations of cefotaxime either by gross inspection or SEM. All stent types showed a similar biofilm structure with relatively uniform thickness on SEM.
  
  
  CONCLUSIONS
  Cefotaxime does not prevent biofilm development in a canine biliary model. Biofilm formation on the inner surface of biliary stents may be prevented by using broad-spectrum antimicrobial agents and stents that maintain a steady release of these agents for a long time, thus prolonging stent patency.
authors.affiliation: Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Gwon
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Kim
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001652:Bile Ducts / Q000601:surgery*; D018441:Biofilms / Q000187:drug effects*; D002439:Cefotaxime / Q000494:pharmacology*; D004285:Dogs; D054855:Drug-Eluting Stents; D008297:Male; D008855:Microscopy, Electron, Scanning; D016459:Prosthesis-Related Infections / Q000517:prevention & control*
chemical_list: D000900:Anti-Bacterial Agents; D002439:Cefotaxime