Mufty Hozan, Van den Eynde Jef, Steenackers Hans P, Metsemakers Willem-Jan, Meuris Bart, Fourneau Inge
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.
J Vasc Surg. 2021 Oct;74(4):1386-1393.e1. doi: 10.1016/j.jvs.2021.04.055. Epub 2021 May 19.
Vascular graft infection (VGI) is a serious complication with high mortality and morbidity rates. Several measures could be taken to decrease this risk, including the use of silver-containing vascular grafts. However, to date, no clinical advantages have been reported. This study reviews the outcome of preclinical studies focusing on the role of commercially available silver-coated grafts in the prevention of VGI.
A systematic review was performed with a focus on the preclinical role of commercially available silver-coated vascular grafts in the prevention and treatment of VGI. A comprehensive search was conducted in Medline, Embase, and Web of Science.
Nine in vitro and five in vivo studies were included. Two commercial grafts were used (INTERGARD SILVER and Silver Graft). In vitro studies used both gram-positive and gram-negative strains. A positive antimicrobial effect was observed in seven of nine studies (77.8%). A delayed antifungal effect against Candida species was observed in vitro, but disappeared when adding serum proteins. In vivo studies witnessed a microbicidal effect in two out of five studies (40%), but only tested a single causative pathogen (ie, Staphylococcus aureus).
Both in vitro and in vivo studies demonstrated conflicting and mixed results concerning the antimicrobial efficacy of commercially available silver-containing grafts in the prevention of VGI. In general, the study setup was heterogeneous in the different articles. Given the lack of convincing preclinical evidence and their poor performance in clinical studies, more data are needed at this time to guide the appropriate use of silver grafts.
血管移植物感染（VGI）是一种严重的并发症，死亡率和发病率都很高。可以采取多种措施来降低这种风险，包括使用含银血管移植物。然而，迄今为止，尚未有临床优势的报道。本研究回顾了临床前研究的结果，重点关注市售银涂层移植物在预防VGI中的作用。
进行了一项系统综述，重点关注市售银涂层血管移植物在预防和治疗VGI中的临床前作用。在Medline、Embase和科学网进行了全面检索。
纳入了9项体外研究和5项体内研究。使用了两种商业移植物（INTERGARD SILVER和Silver Graft）。体外研究使用了革兰氏阳性菌和革兰氏阴性菌菌株。9项研究中有7项（77.8%）观察到了积极的抗菌效果。在体外观察到对念珠菌属的延迟抗真菌作用，但加入血清蛋白后这种作用消失。体内研究在5项研究中有2项（40%）观察到了杀菌效果，但仅测试了单一病原体（即金黄色葡萄球菌）。
关于市售含银移植物在预防VGI中的抗菌效果，体外和体内研究都显示出相互矛盾和混杂的结果。总体而言，不同文章中的研究设置存在异质性。鉴于缺乏令人信服的临床前证据以及它们在临床研究中的不佳表现，目前需要更多数据来指导银移植物的合理使用。
