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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2000 June;19(2):158-65

lingua: Inglese

Does in situ replacement of a staphylococcal infected vascular graft with a rifampicin impregnated gelatin sealed Dacron graft reduce the incidence of subsequent infection?

Vicaretti M., Hawthorne W., Ao P. Y., Fletcher J. P.

From ­the Department of Surgery, University of Sydney ­and Westmead Hospital, Sydney, Australia


Background. The ­aim of ­this ­study ­was to ­treat meth­i­cil­lin-resist­ant Staphylococcus aure­us (­MRSA) or S. epi­der­mi­dis pros­thet­ic vas­cu­lar ­graft infec­tions by in ­situ replace­ment ­with a rifam­pi­cin bond­ed Gelsoft ­graft.
Methods. Interposition ­grafts ­were ­placed in ­the carot­id ­artery of 56 ­sheep ­and ­the ­graft sur­face direct­ly inoc­u­lat­ed ­with 108 col­o­ny form­ing ­units of ­MRSA or S. epi­der­mi­dis. At ­three ­weeks, ­grafts ­were har­vest­ed ­and ­sheep allo­cat­ed to ­three ­groups. In ­the ­MRSA ­group, ­sheep ­received ­grafts ­soaked in 1.2 mg/ml (12), 10 mg/ml (10) ­and no rifam­pi­cin (7). For S. epi­der­mi­dis, ­sheep ­received ­grafts ­soaked in 1.2 mg/ml (10), 10 mg/ml (9) ­and no rifam­pi­cin (8). There ­were ­two ­deaths, in ­the ­MRSA ­study ­group. Remaining ­sheep ­were eutha­nased ­and ­grafts har­vest­ed ­three ­weeks fol­low­ing regraft­ing. Swabs ­were tak­en to ­assess bac­te­ri­al ­growth in ­the per­i­graft tis­sues, ­and exter­nal ­and inter­nal ­graft sur­fac­es. A 3-5 mm seg­ment of ­graft ­was incu­bat­ed in ­broth medi­um.
Results. For ­MRSA, no sta­tis­ti­cal dif­fer­ence ­between ­the ­groups ­was ­reached ­for ­any of ­the meas­ured param­e­ters. For S. epi­der­mi­dis, a sig­nif­i­cant reduc­tion ­was ­reached ­for ­total infect­ed spec­i­mens in ­the 10 mg/ml ­group com­pared to ­both con­trol (p<0.001) ­and 1.2 mg/ml (p<0.005) ­groups. Graft re-in­fec­tion ­was ­also ­less like­ly to ­occur ­with S. epi­der­mi­dis ­than ­MRSA.
Conclusions. Replacement of S. epi­der­mi­dis infect­ed vas­cu­lar ­grafts ­with 10 mg/ml rifam­pi­cin ­soaked Gelsoft ­graft is effec­tive in reduc­ing sub­se­quent S. epi­der­mi­dis infec­tion. This con­clu­sion can­not be extend­ed to ­MRSA infect­ed vas­cu­lar ­grafts.

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