Kodjikian Laurent, Renaud François N R, Roques Christine, Garweg Justus G, Pellon Gérard, Freney Jean, Burillon Carole
Department of Ophthalmology, Croix-Rousse Hospital, Lyon 69004, France.
J Cataract Refract Surg. 2005 May;31(5):1050-8. doi: 10.1016/j.jcrs.2004.07.026.
To assess anti-adhesion and/or bactericidal properties of vancomycin in vitro and to determine when these effects are detectable to estimate its relevance to perioperative antibiotic prophylaxis and analyze the efficacy of a newly designed vancomycin insert prototype for endophthalmitis prevention.
University research laboratory, Lyon, France.
Staphylococcus epidermidis clinical strain N890074 containing the intercellular adhesion locus ica was used as the infectious agent. Vancomycin was used at 20 microg/mL. A sterile biocompatible, biodegradable vancomycin insert, releasing 230 microg of antibiotics over 100 minutes, was designed especially for this study. To obtain bacterial killing curves, experiments were first performed in a 103 colony-forming units (CFU/mL) bacterial suspension containing no intraocular lenses (IOL). Then IOLs were incubated in the suspension, and bacterial adherence was determined using bacterial counting with and without antibiotic.
Vancomycin (solution and insert) had an anti-adhesion effect after 1 hour and a relevant bactericidal effect after 6 hours of incubation.
Vancomycin used with irrigating solutions does not remain in the anterior chamber long enough to develop bactericidal effect. Even if it initially reduces bacterial adhesion, used at a drug level dropping below the bacterial minimal inhibitory concentration, it could result in a secondary increase of the adhesion of slime-producing bacteria. A sufficiently high concentration was obtained in vitro by the new sustained-release system, thereby overcoming the theoretical drawback of a short half-life within the anterior chamber. Anti-adhesion and bactericidal action of vancomycin inserts remains to be confirmed in clinical studies.
评估万古霉素的体外抗粘连和/或杀菌特性，确定这些作用何时可被检测到，以评估其与围手术期抗生素预防的相关性，并分析一种新设计的用于预防眼内炎的万古霉素植入物原型的疗效。
法国里昂的大学研究实验室。
使用含有细胞间粘附位点ica的表皮葡萄球菌临床菌株N890074作为感染因子。万古霉素的使用浓度为20微克/毫升。专门为该研究设计了一种无菌、生物相容性、可生物降解的万古霉素植入物，在100分钟内释放230微克抗生素。为了获得细菌杀灭曲线，首先在不含人工晶状体（IOL）的103个菌落形成单位（CFU/毫升）细菌悬液中进行实验。然后将IOL在悬液中孵育，并通过有抗生素和无抗生素情况下的细菌计数来确定细菌粘附情况。
万古霉素（溶液和植入物）在孵育1小时后具有抗粘连作用，孵育6小时后具有显著的杀菌作用。
与冲洗液一起使用的万古霉素在前房内停留的时间不足以产生杀菌作用。即使它最初能减少细菌粘附，但在药物水平降至细菌最低抑菌浓度以下时使用，可能会导致产粘液细菌的粘附继发性增加。新的缓释系统在体外获得了足够高的浓度，从而克服了在前房内半衰期短的理论缺陷。万古霉素植入物的抗粘连和杀菌作用仍有待临床研究证实。
