title: Enhanced Antimicrobial Effects of Decellularized Extracellular Matrix (CorMatrix) with Added Vancomycin and Gentamicin for Device Implant Protection.
abstract: BACKGROUND
  The incidence of cardiac implantable electronic device (CIED) infections has risen significantly over the past years. Although several devices are currently available to decrease the incidence of infection, most are made from nonviable synthetic material and are more prone to infection than vascularized tissue.
  
  
  OBJECTIVE
  This study was undertaken to assess the resistance to infection of the CorMatrix CanGaroo (CorMatrix Cardiovascular, Roswell, GA, USA), a CIED envelope made of decellularized extracellular matrix (ECM) hydrated in different antibiotic solutions.
  
  
  METHODS
  This study was comprised of two in vitro tests and one animal trial. For all the tests, the ECM was hydrated in a mixture of vancomycin (25 mg/mL) and gentamicin (20 mg/mL) or gentamicin alone (40 mg/mL). The drug elution characteristics were assessed followed by the effectiveness of CanGaroo to prevent the bacterial growth of Staphylococcus aureus and Staphylococcus epidermidis in culture. Then, the direct inoculation of pacemaker implant pockets with both Staphylococcus species was performed in rabbits implanted with either a pacemaker alone or a pacemaker with antibiotic-soaked CorMatrix ECM pouches.
  
  
  RESULTS
  The hydration of CanGaroo envelopes in both antibiotic mixtures resulted in antimicrobial activity against both Staphylococcus species, with an early bolus release of antibiotics followed by a slow release lasting for up to 6 days. In vivo, there was a substantial decrease in the occurrence of infection.
  
  
  CONCLUSIONS
  The hydration of the CanGaroo ECM with an antibiotic solution prevented Staphylococcus species growth in vitro and substantially reduced the incidence of CIED pocket infections in an in vivo rabbit model.
authors.affiliation: Clinical Centers of Excellence & Arrhythmia Center of Excellence, Piedmont Heart Institute, Atlanta, Georgia.|Cardiovascular Services, Piedmont Atlanta Hospital, Atlanta, Georgia.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Deering
authors.affiliation: CorMatrix Cardiovascular, Roswell, Georgia.
authors.forename: Carlos
authors.initials: C
authors.lastname: Chang
authors.affiliation: CorMatrix Cardiovascular, Roswell, Georgia.
authors.forename: Carl
authors.initials: C
authors.lastname: Snyder
authors.affiliation: CorMatrix Cardiovascular, Roswell, Georgia.
authors.forename: Selvamuthu K
authors.initials: SK
authors.lastname: Natarajan
authors.affiliation: CorMatrix Cardiovascular, Roswell, Georgia.
authors.forename: Robert
authors.initials: R
authors.lastname: Matheny
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002474:Cell-Free System / Q000737:chemistry; D003131:Combined Modality Therapy / Q000379:methods; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004338:Drug Combinations; D005109:Extracellular Matrix / Q000737:chemistry / Q000637:transplantation*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D008565:Membrane Proteins / Q000187:drug effects*; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000517:prevention & control*; D011817:Rabbits; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000517:prevention & control*; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D005839:Gentamicins; D008565:Membrane Proteins; C477297:MsrR protein, Staphylococcus aureus; D014640:Vancomycin
keywords: cardiac implantable electronic device; extracellular matrix; infection