Muhl E, Gatermann S, Iven H, Dendorfer A, Bruch H P
Department of Surgery, University of Luebeck, Germany.
Ann Vasc Surg. 1996 May;10(3):244-53. doi: 10.1007/BF02001890.
Methicillin-resistant strains of Staphylococcus epidermidis cause an increasing number of prosthetic infections. This prompted us to test the uptake of vancomycin in various graft materials in vitro, its influence on graft healing, and its efficacy against graft infection in pigs. Incubation of six different Dacron graft materials in a vancomycin solution (20 gm/L) was performed. Grafts were then placed in plasma, and samples were taken over 72 hours to determine vancomycin levels. Release of vancomycin ranged from 775 micrograms/cm2 to 3691 micrograms/cm2 after 1 hour of incubation. Gelatin-covered grafts increased release of vancomycin fourfold when incubation time was extended to 24 hours: uncovered grafts or the collagen-covered graft did not. Graft healing was not complicated when a vancomycin-bonded, gelatin-impregnated Dacron graft was implanted to replace the common femoral artery in pigs. Four weeks after implantation, histologic examination revealed normal development of neointima and perigraft scar tissue in the vancomycin-treated (n = 4) and untreated (n = 5) grafts. To test the efficacy of local vancomycin against graft infection, grafts were implanted in the groin of pigs and contaminated with 2 x 10(7) colony-forming units of Staphylococcus aureus. Four weeks after implantation, all grafts were infected in the untreated group (n = 6), with abscess, nonincorporated graft, and detection of S. aureus from the graft. In the treatment group (n = 6) vancomycin was added to the contaminated grafts. As a carrier for the vancomycin, we used a resorbable gelatin-glycerol foam. All grafts healed without infection. The difference between the treated and untreated groups is statistically significant (p < 0.05). We conclude that it may be effective to prevent graft infection with local application of vancomycin if an in situ replacement of infected graft (infected by gram-positive bacteria) is necessary or if there is a high risk of infection by methicillin-resistant- staphylococci.
耐甲氧西林表皮葡萄球菌菌株导致越来越多的人工假体感染。这促使我们在体外测试各种移植材料对万古霉素的摄取情况、其对移植愈合的影响以及其对猪移植感染的疗效。将六种不同的涤纶移植材料置于万古霉素溶液（20 g/L）中进行孵育。然后将移植材料置于血浆中，并在72小时内取样以测定万古霉素水平。孵育1小时后，万古霉素的释放量在775微克/平方厘米至3691微克/平方厘米之间。当孵育时间延长至24小时时，明胶包被的移植材料使万古霉素的释放量增加了四倍：未包被的移植材料或胶原包被的移植材料则没有。当将结合万古霉素、浸渍明胶的涤纶移植材料植入猪体内以替代股总动脉时，移植愈合未出现并发症。植入四周后，组织学检查显示，经万古霉素处理的移植材料（n = 4）和未处理的移植材料（n = 5）中新内膜和移植周围瘢痕组织发育正常。为了测试局部应用万古霉素对移植感染的疗效，将移植材料植入猪的腹股沟并接种2×10⁷个金黄色葡萄球菌菌落形成单位。植入四周后，未处理组（n = 6）的所有移植材料均被感染，出现脓肿、移植材料未融合以及从移植材料中检测到金黄色葡萄球菌。在治疗组（n = 6）中，将万古霉素添加到受污染的移植材料中。作为万古霉素的载体，我们使用了可吸收的明胶 - 甘油泡沫。所有移植材料均愈合且未发生感染。治疗组和未治疗组之间的差异具有统计学意义（p < 0.05）。我们得出结论，如果需要原位替换感染的移植材料（被革兰氏阳性菌感染）或存在耐甲氧西林葡萄球菌感染的高风险，局部应用万古霉素预防移植感染可能是有效的。
