Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin
Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin
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DOI：
10.1016/j.jtcvs.2007.06.027
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发表时间：
2008-01-01
影响因子：
6
通讯作者：
Komeda, Masashi
中科院分区：
文献类型：
--
作者：
Sakaguchi, Hisashi;Marui, Akira;Komeda, Masashi
目的：耐甲氧西林金黄色葡萄球菌感染是血管外科手术中最严重的并发症之一。万古霉素是对抗耐甲氧西林金黄色葡萄球菌的有效抗生素；然而，全身给药万古霉素对耐甲氧西林金黄色葡萄球菌移植物感染不是很有效。因此，我们研究了万古霉素的局部缓释是否能预防耐甲氧西林金黄色葡萄球菌移植物感染。方法：研制了一种万古霉素缓释2周的聚l -乳酸-co-己内酯片。在切开的小鼠腹主动脉前壁处缝合一个扩大的聚四氟乙烯血管移植贴片（1.5 mm(2)）。将耐甲氧西林金黄色葡萄球菌（1.0 × 10(3)个菌落形成单位）接种于移植物表面。随后，移植物分为不处理组（对照组）、局部注射万古霉素水溶液组（万古霉素溶液组）和局部植入含万古霉素的聚l -乳酸-己内酯（万古霉素- plca组）。7 d后，取移植物和血液进行培养。结果：万古霉素- plca组移植物中耐甲氧西林金黄色葡萄球菌计数明显低于其他组。万古霉素- plca组血培养均为阴性，其余各组血培养均为感染阳性。万古霉素- plca组28天生存率明显高于对照组（83.3% vs 16.7%）。结论：含有万古霉素的局部缓释片可减少感染血管移植物中耐甲氧西林金黄色葡萄球菌计数，预防败血症，并显著提高生存率。这可以作为一种高效、微创的辅助治疗方法，预防假体耐甲氧西林金黄色葡萄球菌移植物感染。
Objective: Methicillin-resistant Staphylococcus aureus graft infection is one of the most serious complications of vascular surgery. Vancomycin is a potent antibiotic against methicillin-resistant S aureus; however, systemic administration of vancomycin is not very effective against methicillin-resistant S aureus graft infection. Therefore, we investigated whether a local sustained release of vancomycin prevents methicillin-resistant S aureus graft infection.Methods: We have developed a poly-L-lactide-co-caprolactone sheet that enabled sustained release of vancomycin for 2 weeks. An expanded polytetrafluoroethylene vascular graft patch (1.5 mm(2)) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S aureus (1.0 x 10(3) colony-forming units) was inoculated onto the graft surface. Thereafter, the graft was treated as follows (n = 6 each): no treatment (control group), local injection of an aqueous solution of vancomycin (vancomycin solution group) and local implantation of poly-L-lactide-co-caprolactone containing vancomycin (vancomycin-PLCA group). After 7 days, the graft and blood were sampled and cultured.Results: The methicillin-resistant S aureus counts in the grafts of the vancomycin-PLCA group were significantly lower than those of the other groups. Blood cultures of the vancomycin-PLCA group were all negative, whereas those of the other groups were all positive for infection. The survival rate in the vancomycin-PLCA group at 28 days was considerably higher than that in the control group (83.3% vs 16.7%).Conclusions: A local sustained-release sheet containing vancomycin reduced methicillin-resistant S aureus counts in the infected vascular grafts, prevented sepsis, and drastically improved survival rates. This can be used as a highly effective and less-invasive adjunctive treatment method for preventing prosthetic methicillin-resistant S aureus graft infection.