缓释万古霉素片可能有助于预防人工血管耐甲氧西林金黄色葡萄球菌感染。

Sustained-release vancomycin sheet may help to prevent prosthetic graft methicillin-resistant Staphylococcus aureus infection.

作者信息

Hirose Keiichi, Marui Akira, Arai Yoshio, Nomura Takamasa, Inoue Sachiko, Kaneda Kozo, Kamitani Tetsuya, Fujita Masatoshi, Mitsuyama Masao, Tabata Yasuhiko, Komeda Masashi

机构信息

Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.

出版信息

J Vasc Surg. 2006 Aug;44(2):377-82. doi: 10.1016/j.jvs.2006.03.043.

DOI:10.1016/j.jvs.2006.03.043

PMID:16890872

Abstract

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of a sustained-release sheet with vancomycin (VCM) to prevent prosthetic graft infection.

METHODS

VCM was incorporated into a poly-L-lactide-co-caprolactone (PLCA) sheet (VCM-PLCA). The release profile of VCM from the VCM-PLCA sheet and the tissue concentration of VCM released in vivo were examined. To assess the antibacterial effect of the VCM-PLCA sheet, a sterile Dacron sheet was implanted into 96 male mice (C57BL/6), who were randomly divided into four groups of 24 each and treated as follows: no treatment (group A, control group), a local bolus injection of an aqueous solution of VCM (group B), a plain PLCA sheet (group C), and a VCM-PLCA sheet (group D). After the treatment, methicillin-resistant Staphylococcus aureus (MRSA) (1 x 10(6) colony forming units) was inoculated onto the Dacron graft surface. The Dacron grafts were retrieved on days 3, 7, 10, and 14 after the implantation, and the number of MRSA in the Dacron grafts was counted.

RESULTS

VCM was slowly released from the VCM-PLCA sheet over 2 weeks in vivo, and the mean in vivo concentrations of VCM in the tissue around a VCM-PLCA sheet were 7.95, 26.39, 13.87, 12.51, 8.36, and 10.33 mug/mL (the minimum inhibitory concentration of VCM against MRSA is 2.0 mug/ml), at 1, 2, 5, 7, 10, and 14 days after the implantation, respectively. MRSA colonization on the cultivated agar plates was detected in all samples from groups A, B, and C at any postoperative time points. In contrast, some samples were negative for bacterial cultures in group D (2, 3, 1, and 2 samples out of 6 samples each on days 3, 7, 10, and 14 after the implantation, respectively). At all time points, the number of MRSA bacteria in the implanted Dacron graft in group D was by far the lowest (P < .01 at each time point).

CONCLUSIONS

The sustained-release sheet with VCM appears to be effective for the reduction of subcutaneous prosthetic graft infection.

摘要

目的

本研究旨在评估含万古霉素（VCM）的缓释片预防人工血管移植物感染的有效性。

方法

将VCM掺入聚-L-丙交酯-共-己内酯（PLCA）片（VCM-PLCA）中。检测VCM从VCM-PLCA片中的释放曲线以及体内释放的VCM的组织浓度。为评估VCM-PLCA片的抗菌效果，将无菌涤纶片植入96只雄性小鼠（C57BL/6）体内，这些小鼠被随机分为四组，每组24只，处理如下：不处理（A组，对照组）、局部推注VCM水溶液（B组）、普通PLCA片（C组）和VCM-PLCA片（D组）。处理后，将耐甲氧西林金黄色葡萄球菌（MRSA）（1×10⁶菌落形成单位）接种到涤纶移植物表面。在植入后第3、7、10和14天取出涤纶移植物，计算涤纶移植物中MRSA的数量。

结果

VCM在体内从VCM-PLCA片中缓慢释放2周，植入后1、2、5、7、10和14天，VCM-PLCA片周围组织中VCM的平均体内浓度分别为7.95、26.39、13.87、12.51、8.36和10.33μg/mL（VCM对MRSA的最低抑菌浓度为2.0μg/ml）。在任何术后时间点，A组、B组和C组所有样本的培养琼脂平板上均检测到MRSA定植。相比之下，D组一些样本的细菌培养为阴性（植入后第3、7、10和14天，每组6个样本中分别有2、3、1和2个样本）。在所有时间点，D组植入的涤纶移植物中MRSA细菌数量迄今为止最低（每个时间点P<0.01）。