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Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin.

AbstractOBJECTIVE:
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.
AuthorsHisashi Sakaguchi, Akira Marui, Keiichi Hirose, Takamasa Nomura, Yoshio Arai, Shyamal Chandra Bir, Yuhong Huang, Jiro Esaki, Yasuhiko Tabata, Tadashi Ikeda, Masashi Komeda
JournalThe Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 135 Issue 1 Pg. 25-31 (Jan 2008) ISSN: 1097-685X [Electronic] United States
PMID18179914 (Publication Type: Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Caproates
  • Delayed-Action Preparations
  • Lactones
  • Polyesters
  • poly(lactide)
  • caprolactone
  • Vancomycin
Topics
  • Absorbable Implants
  • Administration, Topical
  • Animals
  • Anti-Bacterial Agents (administration & dosage)
  • Caproates
  • Delayed-Action Preparations
  • Disease Models, Animal
  • Drug Delivery Systems
  • Lactones
  • Male
  • Methicillin Resistance
  • Polyesters
  • Prosthesis-Related Infections (microbiology, prevention & control)
  • Rats
  • Rats, Wistar
  • Staphylococcal Infections (complications, microbiology, prevention & control)
  • Staphylococcus aureus
  • Vancomycin (administration & dosage)

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