Ney A L, Kelly P H, Tsukayama D T, Bubrick M P
Department of Surgery, Hennepin County Medical Center, Minneapolis, MN 55415.
J Trauma. 1990 Aug;30(8):1000-5; discussion 1005-6. doi: 10.1097/00005373-199008000-00009.
The following study was done to assess whether fibrin glue-antibiotic suspension (FGAS) can prevent infection of a PTFE vascular graft in a contaminated wound.
FGAS was made by combining cryoprecipitate with a mixture of bovine thrombin, aminocaproic acid, and tobramycin (5 mg/cc thrombus). Antibiotic activity was documented by in vitro kinetics which revealed initial elutions to be greater than 8,000 mu gm/cc and elutions at 4 days to be greater than 2 mcg/cc. Twelve dogs had a 1-cm section of infrarenal aorta replaced with a PTFE graft that had been bathed in a 2-cc solution of E. coli 3 x 10(8) CFU/ml and S. aureus 3 x 10(8) CFU/ml. Both organisms were sensitive to tobramycin and cefonicid. Dogs were divided into three groups of four. Group I had a contaminated PTFE graft placed and no further therapy. Group II had a contaminated PTFE graft placed and sealed with fibrin glue. Group III had a contaminated PTFE graft placed and sealed with FGAS. All three groups received daily IV cefonicid.
Group I: Four of four dogs were reoperated on the fourth day for suspected sepsis and all four had pseudoaneurysms (one ruptured). Three of four were culture positive for S. aureus and two of four positive for E. coli. Group II: Four of four died of anastomotic disruption by the third day. Four of four were culture positive for S. aureus and E. coli. Group III: All four dogs survived and were sacrificed on Day 17: all anastomoses were normal. Animal survival was significantly associated with the treatment given (p = 0.0025). Three of four tissue cultures of the grafts were weakly positive for S. aureus and one of four for E. coli and Pseudomonas. Serum tobramycin levels were negligible at 12, 24, 72, and 96 hours.
The data show that FGAS was associated with a reduction in vascular graft infection and pseudoaneurysm formation after exposure to a standardized bacterial inoculum. Whether complete eradication of all organisms can be achieved with higher doses of tobramycin is as yet undetermined.
进行以下研究以评估纤维蛋白胶 - 抗生素混悬液（FGAS）能否预防污染伤口中聚四氟乙烯血管移植物的感染。
FGAS通过将冷沉淀与牛凝血酶、氨基己酸和妥布霉素（5毫克/立方厘米血栓）的混合物混合制成。通过体外动力学记录抗生素活性，结果显示初始洗脱量大于8000微克/立方厘米，4天时的洗脱量大于2微克/立方厘米。12只犬的肾下腹主动脉1厘米节段被聚四氟乙烯移植物替代，该移植物已浸泡在含有3×10⁸CFU/毫升大肠杆菌和3×10⁸CFU/毫升金黄色葡萄球菌的2立方厘米溶液中。两种细菌均对妥布霉素和头孢尼西敏感。犬被分为三组，每组四只。第一组植入受污染的聚四氟乙烯移植物且不进行进一步治疗。第二组植入受污染的聚四氟乙烯移植物并用纤维蛋白胶密封。第三组植入受污染的聚四氟乙烯移植物并用FGAS密封。所有三组均每日静脉注射头孢尼西。
第一组：四只犬中有四只在第四天因疑似败血症接受再次手术，全部四只均有假性动脉瘤（一只破裂）。四只中有三只金黄色葡萄球菌培养阳性，四只中有两只大肠杆菌培养阳性。第二组：四只犬中有四只在第三天死于吻合口破裂。四只均金黄色葡萄球菌和大肠杆菌培养阳性。第三组：所有四只犬存活并在第17天处死：所有吻合口均正常。动物存活与所给予的治疗显著相关（p = 0.0025）。移植物的四份组织培养物中有三份金黄色葡萄球菌弱阳性，四份中有一份大肠杆菌和假单胞菌阳性。在12、24、72和96小时时血清妥布霉素水平可忽略不计。
数据表明，FGAS与暴露于标准化细菌接种物后血管移植物感染和假性动脉瘤形成的减少相关。更高剂量的妥布霉素能否实现所有细菌的完全根除尚未确定。
