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International Angiology 1999 September;18(3):225-32


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 inter­nal carot­id ­artery of 56 meri­no sheep and the graft sur­face direct­ly inoc­u­lat­ed with 108 col­o­ny form­ing units (CFU) of MRSA (29) or S. epidermidis (27). At three weeks, ­grafts were har­vest­ed and sheep allo­cat­ed to three ­groups. In the MRSA infect­ed group, sheep ­received ­grafts ­soaked in 1.2 mg/ml (12), 10 mg/ml (10) and no (7) rifam­pi­cin. For S. epi­der­mi­dis, sheep ­received ­grafts ­soaked in 1.2 mg/ml (10), 10 mg/ml (9) and no (8) rifam­pi­cin. There were two ­deaths, in the MRSA study group, one each from the rifam­pi­cin treat­ed ­groups. The remain­ing sheep were eutha­nased and ­grafts har­vest­ed three weeks fol­low­ing regraft­ing. Grafts at har­vests were ­assessed for per­i­graft ­abscess for­ma­tion, anas­to­mot­ic dis­rup­tion and graft throm­bo­sis. 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 a broth medi­um. For S. epi­der­mi­dis the remain­der of the graft was ­ground and then incu­bat­ed in a 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 rein­fec­tion was also less like­ly to occur with S. epi­der­mi­dis than MRSA.
Conclusions. In con­clu­sion, 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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