Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
Eur J Vasc Endovasc Surg. 2021 Jul;62(1):99-118. doi: 10.1016/j.ejvs.2021.02.054. Epub 2021 Apr 9.
Vascular graft infection (VGI) remains an important complication with a high mortality and morbidity rate. Currently, studies focusing on the role of vascular graft coatings in the prevention of VGI are scarce. Therefore, the aims of this study were to survey and summarise key features of pre-clinical in vivo models that have been used to investigate coating strategies to prevent VGI and to set up an ideal model that can be used in future preclinical research.
A systematic review was conducted in accordance with the Preferred reporting items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search was performed in MEDLINE (PubMed), Embase, and Web of Science.
For each database, a specific search strategy was developed. Quality was assessed with the Toxicological data Reliability Assessment Tool (ToxRTool). The type of animal model, graft, coating, and pathogen were summarised. The outcome assessment in each study was evaluated.
In total, 4 667 studies were identified, of which 94 papers focusing on in vivo testing were included. Staphylococcus aureus was the organism most used (n = 65; 67.7%). Most of the graft types were polyester grafts. Rifampicin was the most frequently used antibiotic coating (n = 43, 48.3%). In the outcome assessment, most studies mentioned colony forming unit count (n = 88; 91.7%) and clinical outcome (n = 72; 75%). According to the ToxRTool, 21 (22.3%, n = 21/94) studies were considered to be not reliable.
Currently published in vivo models are very miscellaneous. More attention should be paid to the methodology of these pre-clinical reports when transferring novel graft coatings into clinical practice. Variables used in pre-clinical reports (bacterial strain, duration of activity coating) do not correspond well to current clinical studies. Based on the results of this review, a proposal for a complete and comprehensive set up for pre-clinical invivo testing of anti-infectious properties of vascular graft coatings was defined.
血管移植物感染（VGI）仍然是一种重要的并发症，具有较高的死亡率和发病率。目前，专注于血管移植物涂层在预防 VGI 中的作用的研究很少。因此，本研究的目的是调查和总结用于研究预防 VGI 的涂层策略的临床前体内模型的关键特征，并建立一个可用于未来临床前研究的理想模型。
根据系统评价和荟萃分析的首选报告项目指南进行了系统评价。在 MEDLINE（PubMed）、Embase 和 Web of Science 中进行了全面检索。
为每个数据库开发了特定的搜索策略。使用毒理学数据可靠性评估工具（ToxRTool）评估质量。总结了动物模型、移植物、涂层和病原体的类型。评估了每项研究中的结果评估。
共确定了 4667 项研究，其中 94 篇专注于体内测试的论文被纳入。金黄色葡萄球菌是使用最多的生物体（n=65；67.7%）。大多数移植物类型为聚酯移植物。利福平是最常用的抗生素涂层（n=43，48.3%）。在结果评估中，大多数研究提到了菌落形成单位计数（n=88；91.7%）和临床结果（n=72；75%）。根据 ToxRTool，21 项（22.3%，n=21/94）研究被认为不可靠。
目前发表的临床前模型非常多样化。在将新型移植物涂层转移到临床实践中时，应更加关注这些临床前报告的方法学。临床前报告中使用的变量（细菌株、涂层活性持续时间）与当前的临床研究不太相符。基于本综述的结果，定义了一种用于临床前体内测试血管移植物涂层抗感染性能的完整和全面的设置方案。
