Prevention of pacemaker infections with perioperative antimicrobial treatment: an in vitro study.
OBJECTIVE
The antimicrobial treatment of pacemaker casings with antiseptics (povidone-iodine or octenidine dihydrochloride) or antibiotics (vancomycin, daptomycin, cefuroxime, Tazobac, or nebacetin) was analysed in vitro for its biocompatibility and efficacy in preventing the bacterial adhesion of Staphylococcus epidermidis, Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli to cardiac-implantable electrophysiological devices (CIEDs).


RESULTS
Titan platelets (0.4 cm&sup2;) cut from pacemaker casings were impregnated with seven different antimicrobial solutions: two antiseptics and five antibiotics. Subsequently, they were challenged with bacterial contamination by four test strains over a 24 h incubation period. Bacterial adherence was quantified using the colony-forming-unit method after cell recovery with sonication and examined with confocal laser scanning electron microscopy. Simultaneously, the biocompatibility of the antimicrobial impregnation was assessed using pre-treated titan platelets in a culture of human fibroblasts, skeletal myoblasts, and microvascular endothelial cells. After a 48 h incubation, cell vitality was measured using the 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2H/tetrazolium monosodium (WST-8) assay. The immersion of pacemaker casings in antiseptic or antibiotic solutions applies an antimicrobial coating that can significantly reduce bacterial adhesion. The studied impregnations differed in their antimicrobial efficacy and toxicity.


CONCLUSIONS
Compared with the two antiseptics and the other tested antibiotics, nebacetin showed the best ratio of efficacy to toxicity. Nebacetin showed good in vitro antibacterial activity against both Gram-positive and Gram-negative pathogens without impairing human cell vitality. It is a safe and effective candidate for CIED impregnation.
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg Street 1, D-30625 Hannover, Germany.
Georg
G
Marsch
Bakr
B
Mashaqi
Karin
K
Burgwitz
Theodosios
T
Bisdas
Ludmilla
L
Knigina
Meike
M
Stiesch
Axel
A
Haverich
Christian
C
Kuehn
D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000633:toxicity; D000891:Anti-Infective Agents, Local / Q000494:pharmacology* / Q000633:toxicity; D001414:Bacitracin / Q000494:pharmacology; D001422:Bacterial Adhesion / Q000187:drug effects; D002470:Cell Survival / Q000187:drug effects; D002478:Cells, Cultured; D020099:Coated Materials, Biocompatible; D042783:Endothelial Cells / Q000187:drug effects; D004866:Equipment Contamination / Q000517:prevention & control*; D004867:Equipment Design; D004926:Escherichia coli / Q000187:drug effects / Q000254:growth & development; D005347:Fibroblasts / Q000187:drug effects; D006801:Humans; D032448:Myoblasts, Skeletal / Q000187:drug effects; D009355:Neomycin / Q000494:pharmacology; D010138:Pacemaker, Artificial / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D013212:Staphylococcus epidermidis / Q000187:drug effects / Q000254:growth & development; D013997:Time Factors
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D020099:Coated Materials, Biocompatible; D001414:Bacitracin; C003903:Nebacetin; D009355:Neomycin
Antimicrobial; CIED; Infection; Toxicity