Sacar Mustafa, Goksin Ibrahim, Baltalarli Ahmet, Turgut Huseyin, Sacar Suzan, Onem Gokhan, Ozcan Vefa, Adali Fahri
Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, Denizli, Turkey.
J Surg Res. 2005 Dec;129(2):329-34. doi: 10.1016/j.jss.2005.05.017.
To investigate the prophylactic efficacy of systemic, topical, or combined antibiotic usage in the prevention of late prosthetic vascular graft infection caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and the differential adherence of S. epidermidis to Dacron and ePTFE grafts in a rat model.
Graft infections were established in the back subcutaneous tissue of 120 adult male Wistar rats by implantation of 1-cm(2) Dacron/ePTFE prosthesis followed by topical inoculation with 2 x 10(7) CFU of clinical isolate of MRSE. Each of the series included one group with no graft contamination and no antibiotic prophylaxis (uncontaminated control), one contaminated group that did not receive any antibiotic prophylaxis (untreated control), one contaminated group in which perioperative intraperitoneal prophylaxis with vancomycin (10 mg/kg) was administered, two contaminated groups that received rifampicin-soaked (5 mg/1 ml) or vancomycin-soaked (1 mg/1 ml) grafts, and one contaminated group that received a combination of rifampicin-soaked (5 mg/1 ml) graft with perioperative intraperitoneal vancomycin prophylaxis (10 mg/kg). The grafts were removed sterilely 7 days after implantation and evaluated by using sonication and quantitative blood agar culture.
MRSE had significantly greater adherence to Dacron than ePTFE grafts in the untreated contaminated groups (P < 0.001). Rifampicin had better efficacy than vancomycin in topical application, but the difference was not statistically significant (P > 0.05). Intraperitoneal vancomycin showed a significantly higher efficacy than topical vancomycin or rifampicin (P < 0.001). The best results were provided by a combination of intraperitoneal vancomycin in rifampicin-soaked graft groups (P < 0.001).
The combination of rifampicin and intraperitoneal vancomycin seems to be the best choice for the prophylaxis of late prosthetic vascular graft infections caused by MRSE.
在大鼠模型中研究全身、局部或联合使用抗生素预防耐甲氧西林表皮葡萄球菌（MRSE）所致晚期人工血管移植物感染的效果，以及表皮葡萄球菌在涤纶和膨体聚四氟乙烯（ePTFE）移植物上的黏附差异。
将1平方厘米的涤纶/ePTFE假体植入120只成年雄性Wistar大鼠背部皮下组织，然后局部接种2×10⁷CFU的MRSE临床分离株，建立移植物感染模型。每个系列包括一组无移植物污染且未进行抗生素预防的组（未污染对照组），一组未接受任何抗生素预防的污染组（未治疗对照组），一组围手术期腹腔注射万古霉素（10毫克/千克）进行预防的污染组，两组分别接受利福平浸泡（5毫克/1毫升）或万古霉素浸泡（1毫克/1毫升）移植物的污染组，以及一组接受利福平浸泡（5毫克/1毫升）移植物并围手术期腹腔注射万古霉素预防（10毫克/千克）的污染组。植入7天后无菌取出移植物，通过超声处理和定量血琼脂培养进行评估。
在未治疗的污染组中，MRSE对涤纶移植物的黏附明显高于对ePTFE移植物的黏附（P<0.001）。利福平局部应用的效果优于万古霉素，但差异无统计学意义（P>0.05）。腹腔注射万古霉素的效果明显高于局部应用万古霉素或利福平（P<0.001）。利福平浸泡移植物组联合腹腔注射万古霉素的效果最佳（P<0.001）。
利福平和腹腔注射万古霉素联合使用似乎是预防MRSE所致晚期人工血管移植物感染的最佳选择。
