Basaran M, Kafali E, Ugurlucan M, Kalko Y, Selimoglu O, Us M H, Ogus T N
Goztepe Safak Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey.
Thorac Cardiovasc Surg. 2008 Feb;56(1):28-31. doi: 10.1055/s-2007-965706.
Sternal infection is a serious complication of cardiac surgery requiring resternotomy and radical debridement. In this experimental study, we aimed to test our hypothesis that the use of cyanoacrylate gluing (application of an acrylic resin, a monomer of cyanoacrylate molecules, which rapidly polymerizes in the presence of water, forming long, strong chains and joining the bonded surfaces together) together with systemic antimicrobial therapy will provide synergy for the treatment of sternal infection caused by methicillin-resistant Staphylococcus aureus (MRSA).
Forty Wistar albino rats were randomly divided into four groups: Group I, uncontaminated sham group; Group II, untreated contaminated control group; Group III, contaminated group receiving only systemic vancomycin therapy; Group IV, contaminated group treated with a combination of cyanoacrylate gluing and systemic vancomycin. Cyanoacrylate gluing was applied on the 3rd postoperative day and all rats alive at the end of 8th week were sacrificed. The degree of sternal infection was assessed histologically and also by quantitative culture analysis.
Histological evaluation revealed that cyanoacrylate was degraded and replaced by connective tissue at the end of the 8th week. Culture analysis revealed that the average growth of microorganisms was significantly reduced in Groups III and IV. In Group IV, the reduction in the amount of growing microorganisms was found to be more pronounced and significantly lower than in Groups II and III.
Our experimental model suggests that cyanoacrylate gluing provides significant synergy for systemic antimicrobial therapy. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of mediastinitis and sternal osteomyelitis in rats.
胸骨感染是心脏手术的一种严重并发症，需要再次开胸和彻底清创。在本实验研究中，我们旨在验证我们的假设，即使用氰基丙烯酸酯粘合（应用一种丙烯酸树脂，氰基丙烯酸酯分子的单体，其在水存在下迅速聚合，形成长而牢固的链并将粘合表面连接在一起）联合全身抗菌治疗将为耐甲氧西林金黄色葡萄球菌（MRSA）引起的胸骨感染治疗提供协同作用。
40只Wistar白化大鼠随机分为四组：第一组，未污染的假手术组；第二组，未治疗的污染对照组；第三组，仅接受全身万古霉素治疗的污染组；第四组，接受氰基丙烯酸酯粘合和全身万古霉素联合治疗的污染组。在术后第3天进行氰基丙烯酸酯粘合，第8周结束时处死所有存活的大鼠。通过组织学评估以及定量培养分析来评估胸骨感染程度。
组织学评估显示，第8周结束时氰基丙烯酸酯被结缔组织降解并替代。培养分析显示，第三组和第四组微生物的平均生长显著减少。在第四组中，发现生长微生物数量的减少更为明显，且显著低于第二组和第三组。
我们的实验模型表明，氰基丙烯酸酯粘合为全身抗菌治疗提供了显著的协同作用。然而，尽管我们的研究在大鼠纵隔炎和胸骨骨髓炎治疗中取得了成功结果，但为了在患者中安全使用这种治疗方式，仍需要进一步的临床试验。
