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Junghans S, Rojas SV, Skusa R, Püschel A, Grambow E, Kohlen J, Warnke P, Gummert J, Gross J. Bacteriophages for the Treatment of Graft Infections in Cardiovascular Medicine. Antibiotics (Basel) 2021; 10:antibiotics10121446. [PMID: 34943658 PMCID: PMC8698116 DOI: 10.3390/antibiotics10121446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Bacterial infections of vascular grafts represent a major burden in cardiovascular medicine, which is related to an increase in morbidity and mortality. Different factors that are associated with this medical field such as patient frailty, biofilm formation, or immunosuppression negatively influence antibiotic treatment, inhibiting therapy success. Thus, further treatment strategies are required. Bacteriophage antibacterial properties were discovered 100 years ago, but the focus on antibiotics in Western medicine since the mid-20th century slowed the further development of bacteriophage therapy. Therefore, the experience and knowledge gained until then in bacteriophage mechanisms of action, handling, clinical uses, and limitations were largely lost. However, the parallel emergence of antimicrobial resistance and individualized medicine has provoked a radical reassessment of this approach and cardiovascular surgery is one area in which phages may play an important role to cope with this new scenario. In this context, bacteriophages might be applicable for both prophylactic and therapeutic use, serving as a stand-alone therapy or in combination with antibiotics. From another perspective, standardization of phage application is also required. The ideal surgical bacteriophage application method should be less invasive, enabling highly localized concentrations, and limiting bacteriophage distribution to the infection site during a prolonged time lapse. This review describes the latest reports of phage therapy in cardiovascular surgery and discusses options for their use in implant and vascular graft infections.
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Affiliation(s)
- Simon Junghans
- G. Pohl-Boskamp GmbH & Co. KG, 25551 Hohenlockstedt, Germany;
| | - Sebastian V. Rojas
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany; (S.V.R.); (J.G.)
| | - Romy Skusa
- Department for General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (R.S.); (A.P.); (E.G.); (J.K.)
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany;
| | - Anja Püschel
- Department for General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (R.S.); (A.P.); (E.G.); (J.K.)
| | - Eberhard Grambow
- Department for General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (R.S.); (A.P.); (E.G.); (J.K.)
| | - Juliane Kohlen
- Department for General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (R.S.); (A.P.); (E.G.); (J.K.)
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany;
| | - Jan Gummert
- Department of Cardio-Thoracic Surgery, Heart and Diabetes Centre NRW, University Hospital of the Ruhr-University Bochum, 32545 Bad Oeynhausen, Germany; (S.V.R.); (J.G.)
| | - Justus Gross
- Department for General, Visceral, Thoracic, Vascular and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany; (R.S.); (A.P.); (E.G.); (J.K.)
- Correspondence: ; Tel.:+49-381-494-146007
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DelMauro MA, Kalberer DC, Rodgers IR. Infection prophylaxis in periorbital Mohs surgery and reconstruction: a review and update to recommendations. Surv Ophthalmol 2020; 65:323-347. [DOI: 10.1016/j.survophthal.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
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Kuder M, Gelman A, Zenilman JM. Prevalence of Implanted Medical Devices in Medicine Inpatients. J Patient Saf 2019; 14:153-156. [PMID: 26067750 DOI: 10.1097/pts.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Implanted medical devices (IMDs) are extremely common, yet they are not systematically documented on hospital admission. Through structured patient interviews, we determined the prevalence of IMDs in hospital inpatients. Using medical record review, we evaluated the sensitivity of the medical record reporting of IMDs on an academic medical inpatient service. Fifty-eight percent of 191 interviewees reported 1 or more IMDs. Participants who reported greater than 1 IMD were older and had more frequent hospitalizations. The most common devices reported were surgical mesh, screws, plates, or wires (n = 47); intravascular stents (n = 25); and prosthetic joint replacements (n = 17). Forty-six patients (24%) reported greater than 1 IMD that had not been recorded in their admission history and physical examination. The prevalence of IMDs in hospitalized patients is high and underestimated in the medical record and may have significant implications for patient care.
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Affiliation(s)
| | - Amanda Gelman
- University of Colorado School of Medicine, Aurora, CO
| | - Jonathan M Zenilman
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
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Schutzer R, Hingorani A, Ascher E, Markevich N, Kallakuri S, Jacob T. Early Transposition of the Sartorius Muscle for Exposed Patent Infrainguinal Bypass Grafts. Vasc Endovascular Surg 2016; 39:159-62. [PMID: 15806277 DOI: 10.1177/153857440503900205] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The traditional approach for patent and exposed and infected infrainguinal bypass grafts in the groin has included wide operative debridement and secondary or delayed primary closure. However, this has been associated with significant risk of further contamination and length of stay. The authors reviewed their experience using the wide debridement, sartorius muscle flap transposition, and primary wound closure as an alternative. During the past 5 years, they have had 50 patients with major wound necrosis or infection in the groin or thigh with the graft or native artery being exposed after debridement. This group included 28 men; 74% of the patients had hypertension, 58% had diabetes, and 20% had renal failure. The grafts were split evenly between native vein and prosthetic material. After wide debridement, closure was performed by the vascular surgeon using the sartorius muscle flap. Postoperatively, there was an 8% major amputation rate and a 12% mortality rate in the first 30 days. One patient developed a pseudoaneurysm 5 weeks after placement of the flap. This patient underwent removal of the infected polytetrafluoroethylene graft with ligation of the common femoral artery. None of the procedures have resulted in further systemic or graft sepsis. None have resulted in arterial or graft blowout. Follow-up was for an average of 18 months. Closure of groin and thigh wounds with exposed bypass graft or native artery can be safely performed with the sartorius muscle flap with excellent results. The length of stay of these patients compared to historical controls is acceptable. Furthermore, the chance of infection of the native artery or bypass may be reduced. Familiarity with this simple technique can be a valuable tool for the vascular surgeon.
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Affiliation(s)
- Richard Schutzer
- Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
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Ali AT, Rueda M, Desikan S, Moursi MM, An R, Spencer H, Rueda S, Eidt JF. Outcomes after retroflexed gracilis muscle flap for vascular infections in the groin. J Vasc Surg 2016; 64:452-457. [PMID: 27189769 DOI: 10.1016/j.jvs.2016.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Multiple catheterizations and procedures on the femoral arteries can increase the risk of infection and eventual destruction of the overlying skin and subcutaneous tissue. Without adequate tissue coverage, vascular structures are exposed and, thus, vulnerable to disruption. This can lead to loss of limb and/or life and carries a significant mortality. We hypothesized that gracilis muscle flap (GMF) was a reliable adjunct in providing healthy tissue coverage for a complex surgical problem. METHODS Retrospective review of charts was performed on all patients who had undergone GMF for groin infections at a tertiary care medical center. RESULTS From 1997 to 2012, GMF was performed in 68 limbs (64 patients) by vascular surgeons for infectious etiology to cover the common femoral artery. At the time the GMF was placed, the femoral artery had synthetic graft/patch in 14 limbs, whereas 54 limbs had procedures with autologous conduit. Complete healing was achieved in 58 (85%) limbs. Treatment was deemed not successful in 10 limbs where patients continued to have persistent infection. Six out of 10 limbs had anastomosis disruption requiring emergent ligation of the common femoral artery. Nine patients died during the perioperative period (30-day). There were a total of 13 amputations in 12 patients. Limb salvage was achieved in 55 limbs (81%). Univariate analysis suggested that patients that had revascularization procedures with synthetic graft had a higher complication rate compared with autologous/vein reconstruction (24% vs 5%; P = .021). This group also has a higher rate of persistent infection compared with the autologous group (24% vs 2%; P = .006). Patients older than 75 years at the time of GMF had a higher incidence of GMF-related complications (57% vs 5%; P = .04). Multivariate analysis confirmed that presence of prosthesis led to higher incidence treatment failures and muscle flap complications at the surgical site (odds ratio, 6.6; P = .04; and odds ratio, 13.3; P = .03, respectively). CONCLUSIONS GMF is technically simple to perform and provides durable soft tissue coverage with a high rate of healing for complex groin wounds even in the presence of synthetic conduit.
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Affiliation(s)
- Ahsan T Ali
- Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark.
| | - Mario Rueda
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Sarasijhaa Desikan
- Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Mohammed M Moursi
- Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Ruosu An
- Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Horace Spencer
- Division of Vascular Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Steven Rueda
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John F Eidt
- Department of Surgery, Baylor Heart and Vascular Hospital, Dallas, Tex
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Revest M, Jacqueline C, Boudjemaa R, Caillon J, Le Mabecque V, Breteche A, Steenkeste K, Tattevin P, Potel G, Michelet C, Fontaine-Aupart MP, Boutoille D. New in vitro and in vivo models to evaluate antibiotic efficacy in Staphylococcus aureus prosthetic vascular graft infection. J Antimicrob Chemother 2016; 71:1291-9. [PMID: 26851611 DOI: 10.1093/jac/dkv496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/19/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Prosthetic vascular graft infection (PVGI) is an emerging disease, mostly caused by staphylococci, with limited data regarding efficacy of current antistaphylococcal agents. We aimed to assess the efficacy of different antibiotic regimens. METHODS Six different strains of MSSA and MRSA were used. We compared results of minimal biofilm inhibitory and eradicating concentrations (MBICs and MBECs) obtained with a Calgary Biofilm Pin Lid Device (CBPD) with those yielded by an original Dacron(®)-related minimal inhibitory and eradicating concentration measure model. We then used a murine model of Staphylococcus aureus vascular prosthetic material infection to evaluate efficacy of different antibiotic regimens: vancomycin and daptomycin combined or not with rifampicin for MRSA and the same groups with cloxacillin and cloxacillin combined with rifampicin for MSSA. RESULTS We demonstrated that classical measures of MBICs and MBECs obtained with a CPBD could overestimate the decrease in antibiotic susceptibility in material-related infections and that the nature of the support used might influence the measure of biofilm susceptibility, since results yielded by our Dacron(®)-related minimal eradicating assay were lower than those found with a plastic device. In our in vivo model, we showed that daptomycin was significantly more bactericidal than comparators for some strains of MRSA or MSSA but not for all. For the majority of strains, it was as efficient as comparators. The addition of rifampicin to daptomycin did not enhance daptomycin efficacy. CONCLUSIONS Despite the heterogeneity of results according to bacterial strains, these innovative models represent an option to better evaluate the in vitro efficacy of antibiotics on Dacron(®)-related biofilm S. aureus infections, and to screen different antibiotic regimens in a mouse model of PVGIs.
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Affiliation(s)
- M Revest
- Université Nantes, Faculté Médecine EA3826 Nantes, France CHU Rennes Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, 35033 Rennes Cedex, France CIC Inserm 1414, Rennes 1 University, Pontchaillou Hospital, 35033 Rennes Cedex, France
| | - C Jacqueline
- Université Nantes, Faculté Médecine EA3826 Nantes, France
| | - R Boudjemaa
- Institut des Sciences Moléculaires Orsay, CNRS, Université Paris-Sud, 91405 Orsay, France
| | - J Caillon
- Université Nantes, Faculté Médecine EA3826 Nantes, France
| | - V Le Mabecque
- Université Nantes, Faculté Médecine EA3826 Nantes, France
| | - A Breteche
- Université Nantes, Faculté Médecine EA3826 Nantes, France
| | - K Steenkeste
- Institut des Sciences Moléculaires Orsay, CNRS, Université Paris-Sud, 91405 Orsay, France
| | - P Tattevin
- CHU Rennes Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, 35033 Rennes Cedex, France CIC Inserm 1414, Rennes 1 University, Pontchaillou Hospital, 35033 Rennes Cedex, France
| | - G Potel
- Université Nantes, Faculté Médecine EA3826 Nantes, France
| | - C Michelet
- CHU Rennes Infectious Diseases and Intensive Care Unit, Pontchaillou Hospital, 35033 Rennes Cedex, France CIC Inserm 1414, Rennes 1 University, Pontchaillou Hospital, 35033 Rennes Cedex, France
| | - M P Fontaine-Aupart
- Institut des Sciences Moléculaires Orsay, CNRS, Université Paris-Sud, 91405 Orsay, France
| | - D Boutoille
- Université Nantes, Faculté Médecine EA3826 Nantes, France CHU Nantes, Infectious Diseases Unit, Hôtel Dieu, Nantes, France
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Joh JH, Choi SI, Kim SH, Park HC. Hypogastric Artery Transposition to Restore the Arterial Flow after Resection of the External Iliac Artery. Vasc Specialist Int 2015. [PMID: 26217624 PMCID: PMC4480292 DOI: 10.5758/vsi.2014.30.3.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Tumors in the pelvic cavity frequently involve the iliac vessels. Common and external iliac arteries should be reconstructed to restore the flow to the lower extremity if the tumor directly invades these arteries. We report herein a 58-year-old female patient with a 10×11 cm, recurred uterine leiomyosarcoma. We performed en bloc resection of the tumor mass including the sigmoid colon, left ureter and 5 cm of the left external iliac artery. After complete resection, restoration of arterial flow to the lower extremity was made with a novel strategy of hypogastric artery transposition. There was no evidence of tumor recurrence or vascular insufficiency at 12 months after surgery.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sung-Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang-Hyun Kim
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Ho-Chul Park
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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8
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Jia H, Caputo M, Ghorbel MT. Stem cells in vascular graft tissue engineering for congenital heart surgery. Interv Cardiol 2013. [DOI: 10.2217/ica.13.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kim JT, Yoon YH, Baek WK, Kim KH, Heo YS. Conservative Treatment of a Thoracic Aortic Graft Infection Using an Omental Flap without Graft Removal. Vasc Specialist Int 2012. [DOI: 10.5758/kjves.2012.28.2.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Goëau-Brissonnière O, Javerliat I, Koskas F, Coggia M, Pechère JC. Prothèses vasculaires imprégnées de rifampicine et infections postopératoires. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.acvfr.2011.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Goëau-Brissonnière O, Javerliat I, Koskas F, Coggia M, Pechère JC. Rifampin-Bonded Vascular Grafts and Postoperative Infections. Ann Vasc Surg 2011; 25:134-42. [DOI: 10.1016/j.avsg.2010.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/19/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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Arvela E, Kauhanen P, Albäck A, Lepäntalo M, Neufang A, Adili F, Schmitz-Rixen T. Initial Experience with a New Method of External Polyester Scaffolding for Infrainguinal Vein Grafts. Eur J Vasc Endovasc Surg 2009; 38:456-62. [DOI: 10.1016/j.ejvs.2009.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 05/24/2009] [Indexed: 11/29/2022]
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Terpling S, Schade Larsen C, Schønheyder HC. Long-term home-based parenteral antibiotic treatment of a prosthetic vascular graft infection caused by Pseudomonas aeruginosa. ACTA ACUST UNITED AC 2009; 38:388-92. [PMID: 16709546 DOI: 10.1080/00365540500388800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Survival for more than 5 y was obtained with home-based parenteral antibiotic therapy in a 68-y-old male with Pseudomonas aeruginosa infection of an aortic-bifemoral prosthetic graft. Surgical intervention was deemed to carry to high a risk and we suggest that lifelong suppressive antibiotic therapy may be an option in selected patients.
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Affiliation(s)
- Steen Terpling
- Departments of Infectious Diseases, Aalborg Hospital-Aarhus University Hospital, Aalborg, Denmark
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Sakaguchi H, Marui A, Hirose K, Nomura T, Arai Y, Bir SC, Huang Y, Esaki J, Tabata Y, Ikeda T, Komeda M. Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin. J Thorac Cardiovasc Surg 2008; 135:25-31. [PMID: 18179914 DOI: 10.1016/j.jtcvs.2007.06.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/12/2007] [Accepted: 06/20/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus graft infection is one of the most serious complications of vascular surgery. Vancomycin is a potent antibiotic against methicillin-resistant S. aureus; however, systemic administration of vancomycin is not very effective against methicillin-resistant S. aureus graft infection. Therefore, we investigated whether a local sustained release of vancomycin prevents methicillin-resistant S. aureus graft infection. METHODS We have developed a poly-L-lactide-co-caprolactone sheet that enabled sustained release of vancomycin for 2 weeks. An expanded polytetrafluoroethylene vascular graft patch (1.5 mm2) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S. aureus (1.0 x 10(3) colony-forming units) was inoculated onto the graft surface. Thereafter, the graft was treated as follows (n = 6 each): no treatment (control group), local injection of an aqueous solution of vancomycin (vancomycin solution group) and local implantation of poly-L-lactide-co-caprolactone containing vancomycin (vancomycin-PLCA group). After 7 days, the graft and blood were sampled and cultured. RESULTS The methicillin-resistant S. aureus counts in the grafts of the vancomycin-PLCA group were significantly lower than those of the other groups. Blood cultures of the vancomycin-PLCA group were all negative, whereas those of the other groups were all positive for infection. The survival rate in the vancomycin-PLCA group at 28 days was considerably higher than that in the control group (83.3% vs 16.7%). CONCLUSIONS A local sustained-release sheet containing vancomycin reduced methicillin-resistant S. aureus counts in the infected vascular grafts, prevented sepsis, and drastically improved survival rates. This can be used as a highly effective and less-invasive adjunctive treatment method for preventing prosthetic methicillin-resistant S. aureus graft infection.
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Affiliation(s)
- Hisashi Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sacar M, Onem G, Baltalarli A, Sacar S, Turgut H, Goksin I, Ozcan V, Sakarya S. Neuraminidase produces a decrease of adherence of slime-forming Staphylococcus aureus to gelatin-impregnated polyester fiber graft fabric: an experimental study. J Artif Organs 2007; 10:177-80. [PMID: 17846717 DOI: 10.1007/s10047-007-0383-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 03/29/2007] [Indexed: 10/22/2022]
Abstract
Because slime-forming microorganisms are the major causative agents of graft infections, we aimed to investigate bacterial adherence in slime-forming and nonslime-forming Staphylococcus aureus and to determine the role of neuraminidase (NANase) on adherence to gelatin-impregnated polyester fiber graft fabric. An in vitro model was developed to quantitatively measure bacterial adherence to the surface of the graft. The grafts were divided into two groups - those colonized with slime-forming S. aureus and those colonized with nonslime-forming S. aureus. The grafts were put into sterile tubes and human plasma was instilled and incubated at 37 degrees C to perform fibrin deposition on the grafts. After 48 h of incubation, grafts were drained and inoculated with slime-forming or nonslime-forming S. aureus in triptic soy broth in the presence or absence of NANase. Following 36 h of incubation at 36 degrees C, grafts were vortexed and cultured to perform a colony count. Bacterial counts were expressed as total colony-forming units per square centimeter of graft. Slime-forming S. aureus had greater affinity with the graft compared with nonslime-forming S. aureus (P < 0.05). The adherence of slime-forming S. aureus was impaired by NANase treatment (P < 0.001) but NANase treatment of nonslime-forming S. aureus did not change the adherence to the graft (P > 0.05). These results show that slime plays an important role in the pathogenesis of vascular graft infection. Adherence of slime-forming S. aureus can be decreased by NANase treatment. This may have implications for the development of neuraminidase-embedded vascular grafts to diminish biomaterial-related infections.
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Affiliation(s)
- Mustafa Sacar
- Science and Technology Research and Development Center Laboratories, Adnan Menderes University, Aydin, Turkey
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Kolakowski S, Dougherty MJ, Calligaro KD. Does the timing of reoperation influence the risk of graft infection? J Vasc Surg 2007; 45:60-4. [PMID: 17123767 DOI: 10.1016/j.jvs.2006.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 09/04/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study compared the incidence and characteristics of graft infection in patients who underwent early vs late revisional surgery of lower extremity arterial bypass grafts. METHODS Between 1992 and July 2005, 500 revisional procedures were performed on 198 lower extremity bypass grafts. Patients whose revisions were performed <30 days after the primary bypass were in the early revision (ER) group (n = 99), and those done >30 days after bypass were in the late revision (LR) group (n = 99). Infection was defined as cellulitis with graft exposure or purulence in continuity with a graft that required antibiotics and operation for infection control. Mean follow-up was 60 months (range, 2 to 60 months). Groups were compared using Student's t test. RESULTS The ER group included 66 autogenous and 33 prosthetic grafts. The LR group consisted of 53 autogenous and 46 prosthetic grafts. Of the 500 revisional procedures performed, 17 graft infections occurred (3.4%). Twelve (70.6%) were prosthetic grafts and five (29.4%) were autogenous grafts (P = .004). Defining the infection rate per graft rather than per revisional procedure, the ER group had a significantly higher graft infection rate at 11% (11/99) compared with 6.1% in the LR group (6/99; P = .012). The risk of infection for prosthetic grafts was significantly higher within the ER group at 27.3% (9/33) compared with autogenous grafts at 3.1% (2/66; P = .0001). Infection developed in three vein grafts and three prosthetic grafts in the LR group (P = NS). For prosthetic graft revisions only, infection risk was 27.3% (9/33) in the ER group and 6.5% (3/46) in the LR group (P = .005). The most common cultured pathogen was methicillin resistant Staphylococcus aureus (ER, 6/11 vs LR, 3/6; P = NS). Within the ER group, the prevalence of Pseudomonas aeruginosa was significantly higher at 27.3% (3/11) compared with 0% (0/6) in the LR group (P = .04). CONCLUSIONS Early revision of lower extremity arterial bypass grafts has a significantly higher risk of graft infection compared with revision >1 month after surgery. Infection will develop in approximately 25% (9/33) of prosthetic grafts that are reoperated on early. If feasible, reoperation should be delayed >1 month for prosthetic grafts needing revision. Endovascular or extra-anatomic interventions should be considered if early revision is mandated in this group.
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Affiliation(s)
- Stephen Kolakowski
- Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, PA, USA
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Yasim A, Gul M, Ciralik H, Ergun Y. Gelatin-Sealed Dacron Graft is not more Susceptible to MRSA Infection than PTFE Graft. Eur J Vasc Endovasc Surg 2006; 32:425-30. [PMID: 16725356 DOI: 10.1016/j.ejvs.2006.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Accepted: 03/17/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this experimental study was to compare the susceptibility of gelatin-sealed Dacron and PTFE prostheses to infection by MRSA. DESIGN Prospective, randomized, controlled animal study. MATERIALS AND METHODS Graft infections were established in the subcutaneous tissues of 60 female Spraque-Dawley rats by the implantation of gelatin-sealed Dacron or PTFE prostheses followed by topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1A) uncontaminated gelatin-sealed Dacron group, (1B) untreated contaminated gelatin-sealed Dacron group, (1C) contaminated gelatin-sealed Dacron group with intraperitoneal teicoplanin treatment, (2A) uncontaminated PTFE group, (2B) untreated contaminated PTFE group, and (2C) contaminated PTFE group with intraperitoneal teicoplanin treatment. The grafts were removed after 7 days and evaluated for infection by counting the number of adherent bacteria on the graft material after rinsing and sonication. The perigraft tissue was harvested for histopathological study. To investigate the existence of any infection, blood samples were collected by cardiopuncture for a culture analysis. RESULTS No significant difference in bacteria counts was observed between gelatin-sealed Dacron and PTFE grafts. In groups 1A and 2A, there was no infection detected. The bacterial counts for MRSA were 7.4 x 10(5) in group 1B and 8.6 x 10(5) in group 2B. There was also no infection in groups 1C and 2C. While the difference between group 1B and 2B was not significant (p>.05), bacterial counts in group 1B or 2B were significantly higher than those in other groups. Blood cultures were only positive in four rats in group 1B and in two rats in group 2B. The severities of the inflammation of the perigraft tissues was low in groups 1A and 2A, high in groups 1C and 2C, and between the range from low to moderate in groups 1B and 2B. CONCLUSION The susceptibility of gelatin-sealed Dacron to bacterial infection was not higher than that of PTFE.
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Affiliation(s)
- A Yasim
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Inam University, Turkey.
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Abstract
BACKGROUND Antibiotics are often prescribed in perioperative settings, including dermatologic surgery. Given the continued evolution in the breadth and complexity of cutaneous procedures performed and inevitable localized or distant infections that occasionally occur, it seems prudent to periodically evaluate findings and recommendations from the literature regarding the use of antibiotics in cutaneous surgery. MATERIALS AND METHODS Literature review from English-language sources from the past 30 years, especially focusing on sources from the past 5 to 10 years. Data were examined for a variety of cutaneous surgical procedures, routes of antibiotic administration, and consideration of both cutaneous and distant infections. RESULTS The literature suggests that, for most routine skin procedures, antibiotic use is probably not warranted for the prevention of surgical wound infection, endocarditis, and late prosthetic joint infections. During prolonged Mohs procedures, delayed repairs, grafts, takedowns of interpolation flaps, or any procedure that breaches a mucosal surface, the evidence is less clear, and decisions should be made on a case-by-case basis. Topical antibiotics are probably overused, although silver sulfadiazine may have an undeserved negative reputation among dermatologists. Systemic prophylactic antibiotics for laser resurfacing and liposuction appear not to be routinely necessary, although patients with known prior herpes infection likely should receive antiviral prophylaxis. The overall reported infection rates and infectious complications remain low in dermatologic surgery, and antibiotic therapy may be prescribed excessively or inappropriately as a result. CONCLUSION.: Antibiotics continue to be widely used, and through varying routes of administration, in the setting of dermatologic surgery. Prudent use of these agents is indicated in high-risk patients, certain anatomic locations, and the presence of overt infection. Additional studies may help clarify the most appropriate indications, and in which patient populations, in the future.
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Affiliation(s)
- Michael J Messingham
- Department of Dermatolgy, University of Iowa Hospital and Clinics, Iowa City, 52242, USA
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Yasim A, Gul M, Atahan E, Ciragil P, Aral M, Ergun Y. Efficacy of Vancomycin, Teicoplanin and Fusidic Acid as Prophylactic Agents in Prevention of Vascular Graft Infection: An Experimental Study in Rat. Eur J Vasc Endovasc Surg 2006; 31:274-9. [PMID: 16360328 DOI: 10.1016/j.ejvs.2005.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the efficacy of a single prophylactic dose of intra-peritoneal vancomycin and teicoplanin with anti-biotic treated Dacron grafts (vancomycin, teicoplanin, 10 or 40% fusidic acid-soaked grafts) in preventing vascular graft infections in a rat model. DESIGN Prospective, randomized, controlled animal study. MATERIALS AND METHODS The graft infections were established in the subcutaneous tissues of 80 female Sprague-Dawley rats by the implantation of Dacron prostheses followed by the topical inoculation with methicillin-resistant Staphylococcus aureus. The study groups were as follows: (1) uncontaminated control group, (2) untreated contaminated group, (3) contaminated group with intra-peritoneal vancomycin, (4) contaminated group with intra-peritoneal teicoplanin, (5) contaminated group received vancomycin-soaked Dacron graft, (6) contaminated group received teicoplanin-soaked Dacron graft, (7) contaminated group received 40% fusidic acid-soaked Dacron graft, and (8) contaminated group received 10% fusidic acid-soaked Dacron graft prophylaxis. The grafts were removed after 7 days and evaluated by a quantitative culture analysis. RESULTS No infection was detected in controls. The untreated contaminated group had a high bacteria count (6.0 x 10(4) CFU/cm2 Dacron graft). Groups that received intra-peritoneal vancomycin or teicoplanin had less bacterial growth (4.8 x 10(3) and 3.9 x 10(3)CFU/cm2 Dacron graft, respectively). Similarly, the group that received 10% fusidic acid-soaked graft showed less bacterial growth (3.6 x 10(3) CFU/cm2 Dacron graft). The groups with vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts showed no evidence of infection. Statistical analyses demonstrated that intra-peritoneal prophylactic antibiotic treatment was less effective in inhibiting bacterial growth than high concentration antimicrobial-soaking of grafts. CONCLUSION The use of vancomycin-, teicoplanin- and 40% fusidic acid-soaked grafts was effective in preventing primary prosthetic vascular graft infection.
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Affiliation(s)
- A Yasim
- Department of Cardiovascular Surgery, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Turkey.
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Sacar M, Goksin I, Baltalarli A, Turgut H, Sacar S, Onem G, Ozcan V, Adali F. The Prophylactic Efficacy of Rifampicin-Soaked Graft in Combination with Systemic Vancomycin in the Prevention of Prosthetic Vascular Graft Infection: An Experimental Study. J Surg Res 2005; 129:329-34. [PMID: 16360378 DOI: 10.1016/j.jss.2005.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Revised: 05/23/2005] [Accepted: 05/23/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate the prophylactic efficacy of systemic, topical, or combined antibiotic usage in the prevention of late prosthetic vascular graft infection caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and the differential adherence of S. epidermidis to Dacron and ePTFE grafts in a rat model. MATERIALS AND METHODS Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm(2) Dacron/ePTFE prosthesis followed by topical inoculation with 2 x 10(7) CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture. RESULTS MRSE had significantly greater adherence to Dacron than ePTFE grafts in the untreated contaminated groups (P < 0.001). Rifampicin had better efficacy than vancomycin in topical application, but the difference was not statistically significant (P > 0.05). Intraperitoneal vancomycin showed a significantly higher efficacy than topical vancomycin or rifampicin (P < 0.001). The best results were provided by a combination of intraperitoneal vancomycin in rifampicin-soaked graft groups (P < 0.001). CONCLUSIONS The combination of rifampicin and intraperitoneal vancomycin seems to be the best choice for the prophylaxis of late prosthetic vascular graft infections caused by MRSE.
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Affiliation(s)
- Mustafa Sacar
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
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Turgut H, Sacar S, Kaleli I, Sacar M, Goksin I, Toprak S, Asan A, Cevahir N, Tekin K, Baltalarli A. Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidis graft infection. BMC Infect Dis 2005; 5:91. [PMID: 16242027 PMCID: PMC1274316 DOI: 10.1186/1471-2334-5-91] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Accepted: 10/21/2005] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. Methods Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 107 CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. Results There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05). Conclusion The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance.
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Affiliation(s)
- Huseyin Turgut
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Suzan Sacar
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ilknur Kaleli
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Mustafa Sacar
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ibrahim Goksin
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Semra Toprak
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Nural Cevahir
- Department of Microbiology and Clinical Microbiology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baltalarli
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey
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Borschel GH, Huang YC, Calve S, Arruda EM, Lynch JB, Dow DE, Kuzon WM, Dennis RG, Brown DL. Tissue Engineering of Recellularized Small-Diameter Vascular Grafts. ACTA ACUST UNITED AC 2005; 11:778-86. [PMID: 15998218 DOI: 10.1089/ten.2005.11.778] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A tissue-engineered small-diameter arterial graft would be of benefit to patients requiring vascular reconstructive procedures. Our objective was to produce a tissue-engineered vascular graft with a high patency rate that could withstand arterial pressures. Rat arteries were acellularized with a series of detergent solutions, recellularized by incubation with a primary culture of endothelial cells, and implanted as interposition grafts in the common femoral artery. Acellular grafts that had not been recellularized were implanted in a separate group of control animals. No systemic anticoagulants were administered. Grafts were explanted at 4 weeks for definitive patency evaluation and histologic examination; 89% of the recellularized grafts and 29% of the control grafts remained patent. Elastin staining demonstrated the preservation of elastic fibers within the media of the acellular grafts before implantation. Immunohistochemical staining of explanted grafts demonstrated a complete layer of endothelial cells on the lumenal surface in grafts that remained patent. Smooth muscle cells were observed to have repopulated the vessel walls. The mechanical properties of the matrix were comparable to native vessels. Such a strategy may present an alternative to autologous harvest of small vessels for use in vascular bypass procedures.
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Affiliation(s)
- Gregory H Borschel
- Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Ueberrueck T, Zippel R, Tautenhahn J, Gastinger I, Lippert H, Wahlers T. Vascular graft infections:In vitro andin vivo investigations of a new vascular graft with long-term protection. J Biomed Mater Res B Appl Biomater 2005; 74:601-7. [PMID: 15909300 DOI: 10.1002/jbm.b.30265] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We investigated a polyester vascular prosthesis (PET) coated with elemental silver (SC). Measurement of silver release over a period of 52 weeks by means of inductively coupled plasma atomic emission spectrometry of PET with (PET-G) and without (PET-N) gelatine impregnation revealed a silver release on the first day of 1.2 +/- 0.2 microg (PET-N) and 1.2 +/- 0.1 microg (PET-G) (calculated for 1 g of prosthesis); from the 90th day onward, it was between 0.22 +/- 0.14 microg (PET-N) and 0.18 +/- 0.12 microg (PET-G) per day. The prostheses were incubated with Staphylococcus aureus (S.a.), Staphylococcus epidermidis (S.e.), or Escherichia coli (E.c.) to investigate in vitro antibacterial efficacy. After 6 h of incubation, no colony-forming units were to be seen for any of the bacterial suspensions for PET with SC (p < 0.001). To investigate in vivo antibacterial efficacy, PET-G rings with and without SC contaminated with S.a., S.e., or E.c. were implanted in 18 albino rabbits and examined 7 days after agar culture for 48 h. The silver coating was associated with a significant reduction in bacterial growth (S.a., p = 0.001; S.e., p < 0.005; E.c., p < 0.001). The silver-coated prosthesis, with and without gelatine impregnation, had a significantly antibacterial effect with continuous release of silver.
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Affiliation(s)
- Torsten Ueberrueck
- Friedrich-Schiller University, Department of Cardiothoracic and Vascular Surgery, Jena, Germany.
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Pinocy J, Albes JM, Wicke C, Ruck P, Ziemer G. Treatment of periprosthetic soft tissue infection of the groin following vascular surgical procedures by means of a polyvinyl alcohol-vacuum sponge system. Wound Repair Regen 2003; 11:104-9. [PMID: 12631297 DOI: 10.1046/j.1524-475x.2003.11205.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Deep groin infections after prosthetic vascular surgical procedures represent a serious complication of surgical practice. Septicemia and/or erosive hemorrhage can both be consequences. In this situation, removal of the graft appears to be the only option. However, if the infection is detected early (type Szilagyi III), local treatment to eradicate the infection could serve as an alternative. Twenty-four patients with confirmed infection of the soft tissue adjacent to the prosthetic material in the groin were treated locally by implantation of a vacuum sponge system. Duration of this treatment was 2 weeks. All patients showed excellent tissue granulation of the wound area and the microbial stains were negative at the end of therapy. In 21 patients the wound could be primarily closed after explantation of the sponge. Three patients underwent open treatment because of a skin defect. After 12 months, the wounds had healed well in all patients. Histologic evaluation revealed a physiological healing process. Deep soft tissue infections of the groin adjacent to prosthetic vascular material (type Szilagyi III) can be treated effectively and safely with the vacuum sponge system. The treatment is inexpensive, easy to perform, and the initial vascular reconstruction can be preserved.
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Affiliation(s)
- Jürgen Pinocy
- Department of Surgery, Division of General Surgery, University of Tübingen, Tübingen, Germany.
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Shum-Tim D, Stock U, Hrkach J, Shinoka T, Lien J, Moses MA, Stamp A, Taylor G, Moran AM, Landis W, Langer R, Vacanti JP, Mayer JE. Tissue engineering of autologous aorta using a new biodegradable polymer. Ann Thorac Surg 1999; 68:2298-304; discussion 2305. [PMID: 10617020 DOI: 10.1016/s0003-4975(99)01055-3] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ovine pulmonary valve leaflets and pulmonary arteries have been tissue-engineered (TE) from autologous cells and biodegradable polyglycolic acid (PGA)-polyglactin copolymers. Use of this cell-polymer construct in the systemic circulation resulted in aneurysm formation. This study evaluates a TE vascular graft in the systemic circulation which is based on a new copolymer of PGA and polyhydroxyalkanoate (PHA). METHODS Ovine carotid arteries were harvested, expanded in vitro, and seeded onto 7-mm diameter PHA-PGA tubular scaffolds. The autologous cell-polymer vascular constructs were used to replace 3-4 cm abdominal aortic segments in lambs (group TE, n = 7). In a control group (n = 4), aortic segments were replaced with acellular polymer tubes. Vascular patency was evaluated with echography. All control animals were sacrificed when the grafts became occluded. Animals in TE group were sacrificed at 10 days (n = 1), 3 (n = 3), and 5 months (n = 3). Explanted TE conduits were evaluated for collagen content, deoxyribonucleic acid (DNA) content, structural and ultrastructural examination, mechanical strength, and matrix metalloproteinase (MMP) activity. RESULTS The 4 control conduits became occluded at 1, 2, 55, and 101 days. All TE grafts remained patent, and no aneurysms developed by the time of sacrifice. There was one mild stenosis at the anastomotic site after 5 months postoperatively. The percent collagen and DNA contents approached the native aorta over time (% collagen = 25.7%+/-3.4 [3 months] vs 99.6%+/-11.7 [5 months], p < 0.05; and % DNA = 30.8%+/-6.0 [3 months] vs 150.5%+/-16.9 [5 months], p < 0.05). Histology demonstrated elastic fibers in the medial layer and endothelial specific von Willebrand factor on the luminal surface. The mechanical strain-stress curve of the TE aorta approached that of the native vessel. A 66 kDa MMP-2 was found in the TE and native aorta but not in control group. CONCLUSIONS Autologous aortic grafts with biological characteristics resembling the native aorta can be created using TE approach. This may allow the development of "live" vascular grafts.
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Affiliation(s)
- D Shum-Tim
- Department of Cardiovascular Surgery, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Chalmers RT, Wolfe JH, Cheshire NJ, Stansby G, Nicolaides AN, Mansfield AO, Barrett SP. Improved management of infrainguinal bypass graft infection with methicillin-resistant Staphylococcus aureus. Br J Surg 1999; 86:1433-6. [PMID: 10583291 DOI: 10.1046/j.1365-2168.1999.01267.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is considerable debate over the management of infected infrainguinal grafts. This report describes recent experience in this field and documents the change in clinical practice needed to deal with methicillin-resistant Staphylococcus aureus (MRSA). METHODS All infected infrainguinal grafts between January 1991 and July 1997 were reviewed. In the light of the findings, clinical practice was modified considerably. A further 1 year was audited prospectively up to August 1998. RESULTS Twenty-six patients were treated for 27 infrainguinal graft infections (25 prosthetic, two vein). Twenty were treated by complete graft excision as the initial therapy; graft preservation was attempted in six patients. Before 1995, the infecting organisms were predominantly Pseudomonas aeruginosa or methicillin-sensitive staphylococci. Subsequently all 14 patients treated up to 1997 had infection with MRSA. The overall amputation rate was 17 of 26; ten amputations were in patients with MRSA. Four patients died, all with MRSA sepsis. As a result of this experience a policy of complete isolation was adopted for all patients infected with MRSA. In the 12 months since this policy was introduced, 77 infrainguinal grafts (61 vein, 16 prosthetic) have been inserted. Two grafts (3 per cent) have become infected, necessitating graft excision and amputation. CONCLUSION MRSA infection of an infrainguinal graft is a serious complication with high associated amputation and mortality rates. Isolation and barrier nursing appeared to contain the problem.
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Affiliation(s)
- R T Chalmers
- Regional Vascular Unit, St Mary's Hospital, London, UK
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Braithwaite BD, Davies B, Heather BP, Earnshaw JJ. Early results of a randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction. Joint Vascular Research Group. Br J Surg 1998; 85:1378-81. [PMID: 9782018 DOI: 10.1046/j.1365-2168.1998.00878.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this study was to determine whether the routine use of an antibiotic-bonded gelatin-coated Dacron graft could reduce the incidence of prosthetic graft infection. Extra-anatomic grafts were chosen for study as they have the highest risk of graft infection. This paper reports early results up to 1 month after surgery. METHODS This multicentre study involved 14 vascular units in the UK. A total of 257 patients underwent extra-anatomic bypass. Patients were randomized to rifampicin bonding (1 mg/ml rifampicin soak for 15 min before graft insertion) or a control group. Routine three-dose antibiotic prophylaxis was administered to patients in both groups. RESULTS There were 178 men and 79 women of median age 69 (range 43-92) years. Rifampicin-bonded (n=123) and control (n=134) groups were well matched for clinical details, risk factors and operative techniques. No side-effects were noted from rifampicin bonding. Only one patient (in the control group) developed a graft infection and this proved fatal. There were no significant differences between bonded and unbonded grafts in terms of perioperative mortality rate (9 and 5 per cent respectively), median hospital stay (10 days for both groups), total infective complications (15 and 21 per cent respectively) or need for postoperative antibiotics (13 and 18 per cent respectively). CONCLUSION Early results from this study have not identified any significant advantage in the routine use of rifampicin bonding, but the rate of graft infection was very low (0.4 per cent). Gelatin coating alone may provide protection against infection. Definitive recommendations about the role of antibiotic bonding cannot be made until longer follow-up becomes available.
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