[Show abstract][Hide abstract] ABSTRACT: Aim:
Aim of this study was to assess the rate of incisional hernia in laparoscopic left colectomy comparing two different sites of mini-laparotomy: midline and oblique left iliac fossa.
The study retrospectively analyzed data from 748 patients who underwent laparoscopic left colectomy, in which we performed a midline 6-7 cm incision of the umbilical pubic tract (438 patients - group A), and an oblique left iliac fossa incision (262 patients - group B). Usually a medial to lateral meso-colon dissection technique with vascular closure was performed as a first step. Electro-thermal bipolar energy was routinely used. The variables compared were operative time, hernia in site of mini-laparotomy, conversion, intraoperative bleeding, 30-day complications, wound infection, length of stay.
From early 2004 to April 2012, 748 patients underwent laparoscopic left colectomy, receiving a midline incision for specimen extraction in 438 cases, group A, and off midline in 262, group B. The mean operative time was 135 (90-245) min for group A and 110.5 (40-195) min for group B, and the mean hospital stay was 8 (5-28) days and 6 (4-30) days for group A and B respectively. Forty-eight patients underwent conversion in open surgery and were removed from the study (33 from group A and 15 from group B). Forty-five incisional hernia occurred in group A (10.2%) vs. 3 in group B (1.1%). We shifted to left iliac fossa incision since June 2010.
This study summarizes our experience in the effort to reduce incisional hernia in laparoscopic left colectomy. There was a significant difference in rate of hernia comparing midline and oblique left iliac fossa incision. We postulate anatomy of abdominal wall, dynamics and the higher rate of infection of umbilicus to be the key.
No preview · Article · Oct 2014 · Minerva chirurgica
[Show abstract][Hide abstract] ABSTRACT: Aim:
To describe our experience in treating rectal cancer by transanal endoscopic microsurgery (TEM), report morbidity and mortality and oncological outcome.
A total of 425 patients with rectal cancer (120 T1, 185 T2, 120 T3 lesions) were staged by digital rectal examination, rectoscopy, transanal endosonography, magnetic resonance imaging and/or computed tomography. Patients with T1-N0 lesions and favourable histological features underwent TEM immediately. Patients with preoperative stage T2-T3-N0 underwent preoperative high-dose radiotherapy; from 1997 those aged less than 70 years and in good general health also underwent preoperative chemotherapy. Patients with T2-T3-N0 lesions were restaged 30 d after radiotherapy and were then operated on 40-50 d after neoadjuvant therapy. The instrumentation designed by Buess was used for all procedures.
There were neither perioperative mortality nor intraoperative complications. Conversion to other surgical procedures was never required. Major complications (urethral lesions, perianal or retroperitoneal phlegmon and rectovaginal fistula) occurred in six (1.4%) patients and minor complications (partial suture line dehiscence, stool incontinence and rectal haemorrhage) in 42 (9.9%). Postoperative pain was minimal. Definitive histological examination of the 425 malignant lesions showed 80 (18.8%) pT0, 153 (36%) pT1, 151 (35.5%) pT2, and 41 (9.6%) pT3 lesions. Eighteen (4.2%) patients (ten pT2 and eight pT3) had a local recurrence and 16 (3.8%) had distant metastasis. Cancer-specific survival rates at the end of follow-up were 100% for pT1 patients (253 mo), 93% for pT2 patients (255 mo) and 89% for pT3 patients (239 mo).
TEM is a safe and effective procedure to treat rectal cancer in selected patients without evidence of nodal involvement. T2-T3 lesions require preoperative neoadjuvant therapy.
No preview · Article · Jul 2014 · World Journal of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: The aim of our study was to evaluate the in vitro activity of IB-367 and its bactericidal effect for Pseudomonas aeruginosa and Escherichia coli, associated to a synergic study to test the antibiotic combinations between the peptide and colistin or imipenem. Minimum inhibitory concentrations (MICs), the minimum bactericidal concentration (MBCs), the synergy test and killing study, were carried out to evaluate the IB-367 activity. In the in vivo model, a wound was incised through the panniculus carnosus of BALB/c mice, and then inoculated with 5 × 107 colony-forming units of P. aeruginosa and E. coli. For each strain, the study included an infected or not infected group that did not receive any treatment, and five contaminated groups treated with local IB- 367, intraperitoneal imipenem, intraperitoneal colistin, topical IB-367 local plus intraperitoneal imipenem or intraperitoneal colistin.
All isolates were inhibited by IB-367 at concentrations of 4 to 64 mg/l. Killing by IB-367 was shown to be very rapid: its activity on all gram negative bacteria was completed within a 40 min exposure period at a concentration of 2xMIC/L. Synergy was demonstrated when IB-367 was combined with colistin or imipenem. In in vivo studies, the groups treated with topical IB-367 and intraperitoneal colistin showed the best results in terms of bacterial load inhibition either for Pseudomonas as for E. coli.
The good in vitro activity and in vivo efficacy, as well as, the synergic interactions with antibiotics suggests that IB-367 is a promising candidate for potential application in the treatment of wound gram-negative infections.
[Show abstract][Hide abstract] ABSTRACT: Catheterization is a risk factor for the development of urinary tract infections. On the other side, urinary tract infections in catheterized patients associated with abnormalities increase the risks of therapy failure. Different kinds of microorganisms (bacteria, yeasts) can be associated with urinary infections in catheterized patients. Aim of this review is to summarize the main factors involved in the development of infections in catheterized patients, focusing on the mechanisms related to colonization and biofilm formation. Current prevention and treatment strategies are also reviewed, both referring to experimental studies and to currently approved materials. Our experience in the field of chemically treated materials for preventing infection in intracorporeal urinary catheters (stents) and relevant patents are also reported.
[Show abstract][Hide abstract] ABSTRACT: An in vitro and in vivo study was performed to quantify adhesion and biofilm formation ability of Pseudomonas aeruginosa slime producer under the effect of sub-minimal inhibitory concentrations (MICs) of pexiganan and imipenem. To evaluate adherence, squares of ureteral stents were placed in six-well tissue-culture plates containing 6 ml of a cell suspension grown in the presence of sub-MICs of study antibiotics. To evaluate biofilm formation sterilized squares were placed in six-well tissue culture plates containing 6 ml of triptic soy broth (TSB) supplemented with 0.25% of glucose and the respective amount of antibiotic. For in vivo study a biofilm infection rat model was performed. The study included an uninfected control group to evaluate the sterility of surgical procedure, a group infected with a slime-producer P. aeruginosa strain not previously treated with antibiotics and two groups infected with the strain previously treated with imipenem or pexiganan. Adherence and biofilm in vitro formation was strongly affected by pre-treatment with pexiganan and imipenem, with the latter being the more effective antibiotic. The in vivo results showed a reduction in bacterial load on the ureteral stent tissue of the pre-treated strain. Differently, urine cultures showed no differences in bacterial growth for the pre-treated strain showing that it retained its ability to cause infection. This study suggests that sub-MIC imipenem and pexiganan could be a good strategy to target the adhesion process during the infection cycle.
No preview · Article · Dec 2013 · Le infezioni in medicina: rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive
[Show abstract][Hide abstract] ABSTRACT: Aim:
The outcome after laparoscopic adrenalectomy in 51 patients with pre-Cushing's and Cushing's syndrome was evaluated at six months and one year of follow-up.
In this retrospective analysis of 51 patients (35 females and 16 males) selected for laparoscopic adrenalectomy (28 left and 23 right adrenal glands), clinical presentation, endocrine and blood chemistry and hemodynamics, and pre- and postsurgical management were analyzed. Evaluations included, blood pressure, body-mass index (BMI), lipid profile, blood glucose (fasting insulin and oral glucose tolerance test [OGTT]), liver function and hormonal profile (17-hydroxyprogesterone, dehydroepiandrosterone sulfate and cortisol), and perioperative complications.
Follow-up assessment showed a significant reduction in systolic (12.34 mm Hg) and diastolic blood pressure (11.09 mm Hg), a statistically significant decrease in total (11.67 mg/dL) and a statistically significant increase in high-density lipoprotein (HDL) cholesterol (6.46 mg/dL), and a statistically significant decrease in blood glucose at 60 minutes and an increase in insulin at 120 minutes. No statistically significant changes in the hormone profile were observed. There was a statistically significant reduction in cortisol concentration in response to the dexamethasone test. Mortality was zero and the surgical complications rate was low.
Laparoscopic adrenalectomy has become the gold standard in the treatment of adrenal disease. It is a safe technique, with clinically effective results and an excellent perioperative course.
No preview · Article · Aug 2013 · Minerva chirurgica
[Show abstract][Hide abstract] ABSTRACT: Antimicrobial peptides are known as immunomodulators and antibiotic enhancers. We report that administration of an antimicrobial peptide IB-367 is efficatious in increasing antimicrobial activity of daptomycin or teicoplanin in a mouse model of wound infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Mice were assigned to seven groups: an IB-367 pretreated group with no antibiotics given after challenge, two IB-367 pretreated groups plus daptomycin or teicoplanin given after challenge; two groups treated with only daptomycin or teicoplanin after challenge, and two control groups without infection or that did not receive any treatment. Main outcome measures were: quantitative bacterial culture and analysis of Natural Killer (NK) cytotoxicity and leukocyte phenotype. Wound, established through the panniculus carnosus of mice, was infected by MRSA. Bacterial cultures of mice receiving antibiotics alone showed a -2-log decrease, IB-367 plus daptomycin or teicoplanin determined a -4-log decrease. IB-367 plus daptomycin showed the highest efficacy. The higher antimicrobial effect exerted by IB-367 was associated with increased levels of NK cytotoxicity but not of NK cell number. IB-367 increased the number of both CD11b and GR-1 cells three days after MRSA challenge whereas both these leukocyte populations were reduced at 10 days after challenge. Our data demonstrate that a combination of IB-367 with antibiotic exerts antimicrobial therapeutic effects in the management of staphylococcal wounds and suggest that the enhanced efficacy may be due to increased immunological activity.
Full-text · Article · Jun 2013 · Journal of Medical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that was introduced by Buess in the early 1980s. The TEM procedure employs a dedicated rectoscope with a 3D binocular optic and a set of endoscopic surgical instruments. Since the beginning its advantages have been evident: magnification of the operative field, better access to proximal lesions with lower margin positivity and fragmentation over traditional transanal excision techniques. A non-systematic literature search was performed in the PubMed database to identify all original articles on rectal cancer treated by TEM. Only series including at least ten cases of adenocarcinoma with two years' mean minimum follow-up and published in English were selected. Nowadays more than two decades of scientific data support the use of TEM in the treatment of selected patients with non-advanced rectal cancer. This paper describes the indications and the surgical technique of TEM in the treatment of rectal cancer.
No preview · Article · Feb 2013 · Minerva chirurgica
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the efficacy of distinctin in the management of cutaneous methicillin-resistant Staphylococcus aureus (MRSA) wound infections in an experimental mouse model. Wounds, made in the panniculus carnosus of BALB/c mice, were inoculated with 5 × 10(7) colony-forming units (CFU) of MRSA. Mice were treated with topical distinctin (1 mg/kg of body weight), topical teicoplanin (7 mg/kg of body weight), intraperitoneal teicoplanin (7 mg/kg of body weight); topical teicoplanin and daily intraperitoneal teicoplanin; topical distinctin and daily intraperitoneal teicoplanin. Bacterial cultures of excised tissues and histological examination of microvessel density and of vascular endothelial growth factor (VEGF) expression were studied. It was found that topical distinctin combined with parenteral teicoplanin inhibited bacterial growth to levels comparable with those observed in uninfected animals. Wounded areas of animals treated with distinctin were characterized by a more mature granulation tissue, with a more organized and denser type of connective tissue, compared to mice treated only with teicoplanin. Treatment with topical distinctin had a significant impact on VEGF expression and microvessel density. The combined use of distinctin with teicoplanin may be useful in the management of infected wounds by significantly inhibiting bacterial growth and accelerating the repair process.
No preview · Article · Jun 2012 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: The aim of this work was to determine the in vitro activity of tigecycline and its bactericidal effect for a large number of Gram-positive cocci, as well as to investigate its in vitro interaction with six clinically used antibiotics. In vivo, a wound model was established through the panniculus carnosus of BALB/c mice, and then inoculated with 5 × 10(7) colony-forming units (CFU) of Staphylococcus aureus or Enterococcus faecalis. For each bacterial strain, the study included an infected or non-infected group that did not receive any treatment, three groups singly treated with tigecycline, rifampin, and daptomycin, and two groups that received tigecycline treatment plus rifampin or daptomycin. In the in vitro studies, tigecycline, daptomycin, and teicoplanin were active against all of the 48 Gram-positive isolates. The combination of tigecycline with rifampicin and daptomycin was synergistic against S. aureus and Enterococcus spp. In the in vivo studies, all groups treated with single drugs showed statistically significant results compared to the control group. The two groups treated with a combination of drugs showed the highest antimicrobial efficacy. In conclusion, our results suggested a strong activity of tigecycline alone and in combination with other antimicrobial agents against multi-resistant Gram-positive organisms isolated from wound infections.
No preview · Article · Dec 2011 · European Journal of Clinical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Gram-negative sepsis ranks as the leading cause of death in intensive care units, and its incidence is increasing steadily and mortality rates has not changed much over recent decades.
We investigated the efficacy of the amphibian peptide, citropin 1.1 alone and in combination with tazobactam-piperacillin (TZP) in two experimental mice models of gram-negative sepsis. Animals were given an intraperitoneal injection of (1) 1 mg Escherichia coli 0111:B4 LPS, and (2) 2×10(10) CFU of E. coli ATCC 25922. For each model, all animals were randomized to receive intraperitoneally isotonic sodium chloride solution, 1 mg/Kg citropin 1.1 and 120 mg/Kg of TZP, and finally 1 mg/Kg citropin 1.1 plus 60 mg/Kg of TZP. Lethality, bacterial growth in blood and peritoneum, and oxidative stress indices in plasma were evaluated.
All compounds reduced the lethality compared with controls. Treatment with citropin 1.1 resulted in significant decrease in plasma endotoxin and cytokine levels, while TZP exerted opposed effect. The combination between citropin 1.1 and TZP proved to be the most effective treatment in reducing all variables measured.
Due to its multifunctional properties, citropin 1.1 may become an important future consideration to treat conditions in which oxidative organ failure may be present.
No preview · Article · Dec 2011 · Journal of Surgical Research
[Show abstract][Hide abstract] ABSTRACT: We investigated the in vivo efficacy of tigecycline, a new glycylcycline (a tetracycline derivative), in the management of methicillin-resistant Staphylococcus aureus (MRSA)-infected experimental surgical wounds in rats. The main outcome measures were quantitative bacterial culture, histological examination and immunohistochemical expression of matrix metalloproteinase-9 (MMP-9) and collagen IV.
An animal model was used to compare the in vivo efficacy of teicoplanin and tigecycline in the treatment of burn wound infections by S. aureus. A copper bar, heated in boiling water, was placed on the paraspinal site of each rat, resulting in full thickness burns. A small gauze was placed over each burn and then inoculated with 5 × 10(7) cfu of S. aureus ATCC 43300. To mimic the clinical situation in burn patients, surgical debridement was performed 48 h after the injury. The wounds were left to heal by secondary intention. The study included an uninfected control group that did not receive any treatment, a contaminated group that did not receive any treatment, and two contaminated groups treated with intraperitoneal tigecycline (2 mg/kg) and teicoplanin (7 mg/kg), respectively.
All antibiotic treatments were significantly effective. Tigecycline showed the highest antimicrobial activity, with a better impact on histological results. Infected rats treated with tigecycline showed a significant decrease in MMP-9 expression both in epithelium and in dermis compared with rats treated with teicoplanin.
Tigecycline, besides its antimicrobial activity, exerts an important modulatory effect on MMP-9, accelerating wound healing in staphylococcal-infected burns.
Full-text · Article · Nov 2011 · Journal of Antimicrobial Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: A relevant bacterial load in cutaneous wounds significantly interferes with the normal process of healing. Vitamin E (VE) is a known immunomodulator and immune enhancer. Here, it was shown that administration of VE before infection was effective at increasing the antimicrobial activity of daptomycin (DAP) or tigecycline (TIG) in a mouse model of wound infection caused by meticillin-resistant Staphylococcus aureus (MRSA). A wound was established through the panniculus carnosus of mice and inoculated with MRSA. Mice were assigned to six groups: a VE pre-treated group with no antibiotics given after MRSA challenge; two VE pre-treated groups with DAP or TIG given after MRSA challenge; two groups treated with DAP or TIG only after MRSA challenge; and a control group that did not receive any treatment. Mice receiving each antibiotic alone showed a 3 log decrease in the number of c.f.u. recovered compared with the control group, mice treated with VE plus TIG had a 4 log decrease, whilst mice treated with VE plus DAP had the largest decrease in c.f.u. recovered (5 logs). The increased antimicrobial effect seen from treatment with VE plus antibiotics was associated with increased levels of natural killer cell cytotoxicity, with a more pronounced increase in leukocyte populations in mice treated with VE plus DAP. These data suggest that treatment with VE prior to infection and subsequent antibiotic treatment act in synergy.
Full-text · Article · Aug 2011 · Journal of Medical Microbiology
[Show abstract][Hide abstract] ABSTRACT: Sacral neuromodulation is becoming established as a valid treatment option for patients with anorectal disorders. Nevertheless, despite its efficacy, little is known regarding its mechanism of action. The purpose of this study was to evaluate whether chronic sacral neuromodulation is able to influence the expression of nitric oxide synthetase (NOS) in the anorectum of rats.
Twenty-six female Sprague-Dawley rats were divided into three groups; normal control rats (n = 6); sham treatment (n =10) and group in whom, electrical sacral neuromodulation was performed (n = 10). Bilateral electrode wires were placed in the S1 and electrical stimulation was performed for 14 d. At the end of the procedures the rats were sacrificed, proctectomy was performed, and anorectal specimens were sent to the laboratory for immunostaining with n-NOS and i-NOS.
In the anal and rectal specimens, n-NOS and i-NOS expression was significantly increased in epithelial and muscle cells after neuromodulation of the anus and rectum of the animals.
Our results showed that this model can be applied in further experimental studies to better understand the mechanism of action of sacral neuromodulation in anorectal disorders.
Full-text · Article · Jul 2011 · Journal of Surgical Research
[Show abstract][Hide abstract] ABSTRACT: We investigated the efficacy of tigecycline and rifampin alone or combined in preventing ureteral stent infection due to Enterococcus faecalis.
The activities of the two antibiotics were previously studied in vitro in absence or in presence of biofilm. For in vivo research, the study included a control group without bacterial challenge to evaluate the sterility of surgical procedure, a challenged control group that did not receive any antibiotic prophylaxis and, for each bacterial strain, three challenged groups that received: (1) 2 mg/kg intraperitoneal tigecycline, immediately after stent implantation; (2) rifampin-coated ureteral stents where 0.2 cm(2) sterile ureteral stents were incubated in 10 mg/L rifampin solution for 30 min immediately before implantation; and (3) intraperitoneal tigecycline plus rifampin-coated ureteral stent at the above concentrations. Ureteral stents were explanted at d 5 following implantation and biofilm bacteria enumerated.
The in vitro studies showed that the biofilm was strongly affected by the presence of rifampin and, in its presence, tigecycline had MICs and MBCs lower than those obtained in the absence of rifampin. Intraperitoneal tigecycline exerted stronger effect than rifampin on bacterial numbers. The combination rifampin plus tigecycline showed efficacies higher than that of each single compound.
These results highlight the potential usefulness of tigecycline in preventing enterococcal ureteral stent infections and the role of rifampin as an interesting antibiotic enhancer.
Full-text · Article · May 2011 · Journal of Surgical Research
[Show abstract][Hide abstract] ABSTRACT: Surgical site infections are the second most common hospital- and community-acquired Gram-positive infections, with the US Centers for Disease Control and Prevention estimating that about 500 000 surgical site infections occur annually in the USA. The aim of this work was to determine the in vitro activity of the saponin diosgenyl 2-amino-2-deoxy-β-d-glucopyranoside hydrochloride (HSM1) and its bactericidal effect for a large number of Gram-positive cocci, as well as to investigate its in vitro interaction with seven clinically used antibiotics. In vivo, a wound model was established through the panniculus carnosus of BALB/c mice and then inoculated with 5×10(7) c.f.u. Staphylococcus aureus or Enterococcus faecalis. For each bacterial strain, the study included an infected or non-infected group that did not receive any treatment, a group treated with local HSM1, a group treated with intraperitoneal vancomycin, a group treated with intraperitoneal daptomycin and two groups that received HSM1 local treatment plus intraperitoneal vancomycin or daptomycin. All isolates were inhibited by HSM1 at concentrations of 2-32 mg l(-1). Synergy was demonstrated when HSM1 was combined with vancomycin and daptomycin. In in vivo studies, all groups treated with single drugs showed a statistically significant result compared with the control group. The two groups treated with drug combinations showed the highest antimicrobial efficacy. The good in vitro activities and the in vivo efficacy suggest HSM1 as a promising therapeutic candidate in Gram-positive wound infections.
Preview · Article · Apr 2011 · Journal of Medical Microbiology
[Show abstract][Hide abstract] ABSTRACT: An experimental study was performed to evaluate the interaction between s-thanatin and colistin both in vitro and in vivo, using two Pseudomonas aeruginosa strains with different patterns of susceptibilities. We evaluated whether selecting for colistin-resistant P. aeruginosa could be prevented in vitro by combining colistin with s-thanatin. The strains were serially exposed in broth to twofold stepwise increasing concentrations of colistin alone or in combination with a fixed concentration [0.25× minimum inhibitory concentration (MIC)] of s-thanatin. We also performed an in vitro synergy study. For in vivo studies, a mouse model of Pseudomonas sepsis has been used. Main outcome measures were lethality and quantitative blood cultures. Exposure to colistin alone gradually selected for Pseudomonas strains with an increased MIC. In vitro studies, s-thanatin showed a positive interaction with colistin, and was able to prevent its resistance. In vivo studies, s-thanatin combined with colistin exhibited the highest efficacy on all main outcome measurements. These results highlight the potential usefulness of this combination and provide a future therapeutic alternative in severe Pseudomonas infections.
[Show abstract][Hide abstract] ABSTRACT: An experimental study was performed to evaluate both in vitro and in vivo the kind of interaction between the Laur-CKK-NH2 dimer and daptomycin using two Enterococcus faecalis strains with different patterns of susceptibilities.
We evaluated whether selection for daptomycin-resistant E. faecalis could be prevented in vitro by combining daptomycin with the Laur-CKK-NH2 dimer. The strains were serially exposed in broth to 2-fold stepwise increasing concentrations of daptomycin alone or in combination with a fixed concentration (0.25×MIC) of the Laur-CKK-NH2 dimer. We also performed an in vitro synergy study. For in vivo studies, a mouse model of enterococcal sepsis was used.
In vitro experiments: exposure to daptomycin alone gradually selected for enterococci with increased MICs; and the Laur-CKK-NH2 dimer showed a positive interaction with daptomycin and was able to prevent the resistance. In vivo experiments: the main outcome measures were lethality and quantitative blood cultures; and the Laur-CKK-NH2 dimer combined with daptomycin exhibited the highest efficacy for all main outcome measurements.
These results highlight the potential usefulness of combining daptomycin with the Laur-CKK-NH2 dimer. The combination provides a future therapeutic alternative for the treatment of enterococcal severe infections.
Preview · Article · Mar 2011 · Journal of Antimicrobial Chemotherapy
[Show abstract][Hide abstract] ABSTRACT: An experimental study was performed to evaluate both in vitro and in vivo the efficacy of clarithromycin coating combined with systemic amikacin in preventing ureteral stent biofilm infection due to Pseudomonas aeruginosa.
The activities of the two antibiotics were studied in vitro in the absence or in the presence of biofilm. For the in vivo study we evaluated a control group without bacterial challenge to evaluate the sterility of the surgical procedure, a challenged control group that did not receive any antibiotic prophylaxis and three challenged groups that received (i) 15 mg/kg intraperitoneal amikacin immediately after stent implantation, (ii) clarithromycin-coated ureteral stents where 0.2 cm² sterile ureteral stents were incubated in 10 mg/L clarithromycin solution for 30 min immediately before implantation, and (iii) intraperitoneal amikacin plus a clarithromycin-coated ureteral stent at the above concentrations.
The in vitro studies showed that the biofilm was strongly affected by the presence of clarithromycin and, in its presence, amikacin had MICs and MBCs lower than those obtained in the absence of clarithromycin. For the singly treated groups, intraperitoneal amikacin showed the strongest effect on bacterial numbers. A clarithromycin coating combined with systemic amikacin showed an efficacy that was higher than that of each single compound.
The prevention of ureteral stent Pseudomonas biofilm infection was enhanced by impregnation of the stent with clarithromycin combined with systemic amikacin.
Full-text · Article · Mar 2011 · Journal of Antimicrobial Chemotherapy