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.
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 17(1). · 0.24 Impact Factor
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ABSTRACT: In vascular surgery, the infection of prosthetic vascular grafts represents a serious life-threatening complication. Due to the increasing resistance of hospital micro-organisms to standard antibiotic therapies, maximum effort should be put in the primary prevention of such infections. For this purpose, grafts may be coated with different antibacterial silver formulations. In the present study the different effects of silver acetate-coating and vaporized metallic silver-coating on the vascularization and perigraft inflammation during the initial phase after implantation of Intergard Silver (IS) and Silver Graft (SG) were compared. Silver acetate-coated IS and vaporized metallic silver-coated SG were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study angiogenesis and leukocyte inflammation at the implantation site by means of repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, apoptosis and cell proliferation in the newly developed granulation tissue surrounding the implants was analyzed by immunohistochemistry. IS exhibited an improved vascularization, resulting in a significantly higher functional capillary density when compared to SG. Moreover, the leukocyte inflammatory response to IS was less pronounced, as indicated by a reduced number of adherent leukocytes in perigraft venules. This was associated with a higher proliferative activity of the granulation tissue incorporating the IS when compared to SG. The numbers of apoptotic cells in the perigraft tissue were low and did not differ between the two groups. Silver acetate-coated IS exhibits an improved vascularization and reduced perigraft inflammation during the first 14 days after implantation when compared to vaporized metallic silver-coated SG. This may contribute to reducing the risk of early perigraft seroma formation and subsequent infection.European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery 04/2014; · 2.92 Impact Factor
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ABSTRACT: Objectives Prosthetic graft occlusion following vascular reconstruction is a major cause of morbidity commonly necessitating further limb-salvage revascularization or life-saving amputation. It is therefore surprising that there is scant data in the literature regarding the optimal management of any remnant prosthetic grafts left in situ. We present a case series of three patients with remnant prosthetic graft infection following revisional arterial reconstruction for limb salvage, and a literature review on this topic. Design A retrospective case series and literature review Material and Methods Three patients presented to our institution with remnant prosthetic graft infection between March 2012 and January 2013. They had all undergone previous infra-inguinal bypass surgery with polytetrafluorethylene (PTFE) grafts, which had subsequently thrombosed. Further limb salvage operations with autogenous long saphenous vein bypass in two cases, and above-knee amputation in one case, were performed. In all cases, the focus of infection was confirmed to have originated in the redundant remnant PTFE graft left in situ. These grafts were completely excised and the infected wounds were debrided. All patients made a full recovery. Results and Conclusion: Remnant prosthetic grafts left in situ are shown in this series to be a proven nidus for infection. Published data indicates that these infection rates are greatest in revision vascular surgery and when performing amputations. We propose that routine excision of any occluded remnant prosthetic grafts in revision surgery be considered at the time of revascularization to mitigate against the risk of subsequent infection.Annals of Vascular Surgery 01/2014; · 1.03 Impact Factor