Prevention of Primary Vascular Graft Infection with Silver-Coated Polyester Graft in a Porcine Model
ABSTRACT To evaluate the efficacy of a silver-coated vascular polyester graft in the prevention of graft infection after inoculation with Staphylococcus aureus in a porcine model.
Eighty-four pigs were randomly selected 1:1 to receive a silver-coated or non-silver-coated 8-mm-wide polyester graft implanted end-to-end in the infrarenal aorta. At the end of implantation, 10(6) colony forming units (CFUs) S. aureus in 0.3ml suspension were inoculated directly on the graft surface. Blood samples assayed for white blood corpuscles (WBCs) and C-reactive protein (CRP) were taken before implantation and on the postoperative days 2, 5, 7, 11 and 14. Two weeks after implantation, the perigraft swabs were analysed for S. aureus or contaminants. CFUs of S. aureus were quantified and logarithmised. Student's t-tests, repeated measurement analysis of variance (ANOVA) and chi-square test were employed to compare the two grafts.
All pigs developed graft infection. There were no statistically significant differences between the silver-coated and non-silver-coated grafts in the quantity of S. aureus, macroscopic signs of infection and postoperative changes in the temperature, WBC and CRP.
Silver-coated polyester grafts failed to prevent graft infections after inoculation with 10(6)S. aureus in 0.3ml suspension in a porcine model.
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ABSTRACT: From January 2000 to December 2009, in the Division of Vascular Surgery of the hospitals of Pisa and Naples (Monaldi Hospital), InterGard silver (InterVascular, La Ciotat, France) grafts were implanted in 1,424 patients (93.6% male and 6.4% female) for the treatment of aorto-iliac diseases. The mean age of patients was 71.4 ± 7.4 years. Some patient characteristics were considered as increased risk factors for graft infection; these include diabetes, age >80 years, mycotic aneurysms, and ruptured aneurysms. Hyperleukocytosis, fever >38°C, and wound infections were also recorded. The primary patency at 30 days was 99.7%. At 3, 5, and 10 years it was 95.6 ± 2.2%, 94.3 ± 2.3%, and 93.8% ± 2.7%, respectively. Secondary patency at 10 years was 98.6 ± 1.7%. During hospital stay, 41 patients experienced leukocytosis and 32 had peaks of hyperpyrexia >38%C. Early postoperative complications requiring reintervention occurred in 56 (4%) patients. In the perioperative period (30 days from surgery), 49 wound infections were recorded. Among all 1,424 silver grafts, 5 (0.35%) cases of graft infection have been found: three in the first four months (early infections: 0.21 %) and two later (late infections: 0.14%). Clinical findings at onset of graft infection have been: one case of graft-enteric fistula (0.07%), treated by total graft excision, proximal aortic stump closure, and axillobifemoral bypass; two others cases (0.14%) presented with severe bleeding due to anastomotic disruption that led to patient death. These data, compared to the numbers published in the literature, seem to support the hypothesis that extensive use of silver-acetate-coated Dacron graft could reduce Dacron graft infection, impoving both the immediate and long-term outcome in patients. Nevertheless, accurate selection of patients for elective aorto-iliac surgery, accurate operative technique, and meticulous respect for any perioperative prophylactic measures, are of paramount importance for the prevention of early and late graft infection.
Article: Infektionen von Gefäßprothesen[Show abstract] [Hide abstract]
ABSTRACT: Infektionen von Gefäßprothesen sind schwerwiegende Komplikationen von rekonstruktiven gefäßchirurgischen Eingriffen mit hoher konsekutiver Amputationsrate und Letalität. Ihre Pathogenese ist multifaktoriell, und dementsprechend existieren verschiedenste prophylaktische Ansätze. Neben den Grundsätzen der chirurgischen Asepsis werden zusätzliche Maßnahmen zur Verbesserung der hygienischen Bedingungen in der perioperativen Phase angewandt. Die perioperative Antibiotikaprophylaxe ist in diesem Zusammenhang das einzige Mittel, das einen gewissen Evidenzgrad in Bezug auf die Senkung der Rate von Protheseninfekten erreicht hat. Modifikationen von Prothesen zur Steigerung ihrer Infektresistenz z. B. durch Rifampicin- oder Silberbindung sind seit Langem in Gebrauch, die Datenlage hierfür ist allerdings nicht eindeutig und Gegenstand weiterer Untersuchungen. Ähnliches gilt für die lokale Antibiotikaapplikation z. B. in Form von Gentamicin-Kollagen-Schwämmen. Neue Technologien und antimikrobielle Substanzen werden hier in Zukunft möglicherweise einmal die komplett infektresistente Prothese schaffen.Gefässchirurgie 02/2012; 17(1). DOI:10.1007/s00772-011-0949-4 · 0.24 Impact Factor