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Puges M, M’Zali F, Pereyre S, Bébéar C, Cazanave C, Bérard X. A Narrative Review of Experimental Models to Study Vascular Grafts Infections. EJVES Vasc Forum 2022; 55:30-37. [PMID: 35434684 PMCID: PMC9006669 DOI: 10.1016/j.ejvsvf.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 02/08/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Many experimental models have been developed to decipher the mechanisms of vascular graft and endograft infections (VGEIs), and to elaborate strategies to prevent or treat their occurrence. A systematic literature research was conducted to identify the most accurate models for studying VGEIs, depending on the research question. Methods A narrative literature search was conducted using the MEDLINE and Cochrane databases, with no set limit on the date of publication, up to 10 August 2021. Ex vivo, in vitro, and in vivo animal studies on VGEIs, published in English or French, were selected. Cross references retrieved from selected articles on PubMed database were also included. Data on microorganisms and grafts studied, details of experimental models, and of graft implantation and removal in animal studies were collected. Results A total of 243 studies were included in the review after reading the full length articles: 55 in vitro studies, 169 animal studies, 17 studies which used both in vitro and animal models, and two ex vivo studies. Many differences in model characteristics were seen. The main in vitro model was the incubation of a graft sample in a bacterial solution, used to study the first steps of infection. In animals, vascular large animal models (dogs and pigs) were the most commonly described but supplanted over time by extravascular and particularly subcutaneous mouse and rat models, which have been reported increasingly over the last few years. In animal models, antibiotic prophylaxis and therapy were rarely administered (27.4% and 19.9%, respectively), and vascular reconstruction after VGEIs even less frequently (9.8%). Conclusion Despite protocol discrepancies, it was possible to dinstinguish three main experimental models (i.e., in vitro and in vivo vascular models, and extravascular models), which all remain of interest to study specific phases of VGEIs. Experimental models of vascular (endo)graft infections (VGEIs) can be split into in vitro, extravascular, and vascular ones. Each of these three groups can help answer specific questions on VGEIs. To improve reproducibility, future experimental studies require standardisation. Experimental studies should reproduce real life conditions as accurately as possible.
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Mufty H, Van Den Eynde J, Meuris B, Metsemakers WJ, Van Wijngaerden E, Vandendriessche T, Steenackers HP, Fourneau I. Pre-clinical in vivo Models of Vascular Graft Coating in the Prevention of Vascular Graft Infection: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 62:99-118. [PMID: 33840577 DOI: 10.1016/j.ejvs.2021.02.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/26/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE 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. DATA SOURCES 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. REVIEW METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Hozan Mufty
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium.
| | - Jef Van Den Eynde
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
| | | | - Eric Van Wijngaerden
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Hans P Steenackers
- Department of Microbial and Molecular Systems, Centre of Microbial and Plant Genetics, KU Leuven, Leuven, Belgium
| | - Inge Fourneau
- Department of Vascular Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Research Unit of Vascular Surgery, KU Leuven, Leuven, Belgium
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Salmoukas C, Ruemke S, Rubalskii E, Burgwitz K, Haverich A, Kuehn C. Vascular Graft Pre-Treatment with Daptomycin Prior to Implantation Prevents Graft Infection with Staphylococcus aureus in an In Vivo Model. Surg Infect (Larchmt) 2020; 21:161-168. [DOI: 10.1089/sur.2019.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christina Salmoukas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Stefan Ruemke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Evgenii Rubalskii
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Karin Burgwitz
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
| | - Christian Kuehn
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
- NIFE - Lower Saxony Centre for Biomedical Engineering, Implant Research and Development, Hannover, Germany
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Sumrein HB, Parry SD, Ayer RV, Leonard AP. Infected abdominal aortic aneurysm graft complicated by lumbar discitis. BJR Case Rep 2018; 4:20170101. [PMID: 30363156 PMCID: PMC6159111 DOI: 10.1259/bjrcr.20170101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/22/2018] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
We present the case of a 68-year-old male, who underwent open abdominal aortic graft in August 2016 owing to a ruptured large infrarenal abdominal aneurysm. He subsequently presented 6 months later with back pain, general weakness, reduced mobility and cachexia. He underwent CT, MRI and fluorodeoxyglucose (PDG)-PET spinal imaging, all modalities showing signs of aortic graft infection complicated by L4/5 discitis. The patient was treated conservatively with intravenous antibiotics and spinal brace support, as his general condition did not allow for surgery. Although he showed initial clinical improvement allowing plans for supported discharge, his improvement was not sustained and he died 4 months after admission.
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Affiliation(s)
- Hamzeh B Sumrein
- Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Sally D Parry
- Department of Gastroenterology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Ravi V Ayer
- Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Andrew P Leonard
- Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, UK
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Hansen LK, Berg K, Johnson D, Sanders M, Citron M. Efficacy of Local Rifampin/Minocycline Delivery (AIGISRX®) to Eliminate Biofilm Formation on Implanted Pacing Devices in a Rabbit Model. Int J Artif Organs 2018; 33:627-35. [DOI: 10.1177/039139881003300908] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2010] [Indexed: 11/16/2022]
Abstract
Purpose Device-related infections represent a significant clinical challenge. Once established, these infections prove difficult to treat with existing antibiotic regimens, compromising the health of device recipients, and usually requiring surgical intervention to resolve. The purpose of this study was to determine the ability of the AIGISRX® Anti-Bacterial envelope to reduce the formation of bacterial biofilm on implanted pacing devices. Methods An infection was established in a rabbit model by creating bilateral subcutaneous implant pockets, into which a pacing device with or without AIGISRX® was placed. The incisions were closed, and a defined dose of bacteria was infused into each implant pocket. After seven days, devices were explanted and assessed for viable bacteria by a sonication/vortex procedure to quantify bacteria, and by imaging of the device surface by scanning electron microscopy and laser scanning confocal microscopy. Results The presence of the AIGISRX® envelope eliminated recoverable, viable bacteria from the explanted devices using a vortex/sonication technique from in vivo models of Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, and Escherichia coli infections. Scanning electron microscopy and confocal microscopy demonstrate greatly reduced biological material on the pacemaker surfaces in the presence of the AIGISRX® envelope compared to untreated controls. Conclusion These results demonstrate that in this animal model, the AIGISRX® device reduces the formation of adherent bacteria and reduces bioburden on implanted, infected pacemaker devices.
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Affiliation(s)
| | - Kim Berg
- WuXi AppTec, Inc., St. Paul, Minnesota - USA
| | | | - Mark Sanders
- University of Minnesota, College of Biological Sciences, Imaging Center, St. Paul, Minnesota - USA
| | - Mark Citron
- TYRX, Inc., Monmouth Junction, New Jersey - USA
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Hernandez MD, Mansouri MD, Aslam S, Zeluff B, Darouiche RO. Efficacy of Combination of N-acetylcysteine, Gentamicin, and Amphotericin B for Prevention of Microbial Colonization of Ventricular Assist Devices. Infect Control Hosp Epidemiol 2015; 30:190-2. [DOI: 10.1086/593205] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We assessed the in vitro antimicrobial activity and the in vivo efficacy of dipping ventricular assist devices in a combination of N-acetylcysteine, gentamicin, and amphotericin B (NAC/G/A). Ventricular assist devices dipped in NAC/G/A exhibited broad-spectrum antimicrobial activity in vitro and were less likely than undipped devices to become colonized with Staphylococcus aureus in a rabbit model.
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Owen K, Wilshaw SP, Homer-Vanniasinkam S, Bojar R, Berry H, Ingham E. Assessment of the Antimicrobial Activity of Acellular Vascular Grafts. Eur J Vasc Endovasc Surg 2012; 43:573-81. [DOI: 10.1016/j.ejvs.2012.01.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 01/26/2012] [Indexed: 11/15/2022]
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Letouzey V, Lavigne JP, Garric X, Coudane J, de Tayrac R, Callaghan DO. Is degradable antibiotic coating for synthetic meshes provide protection against experimental animal infection after fascia repair? J Biomed Mater Res B Appl Biomater 2011; 100:471-9. [PMID: 22102417 DOI: 10.1002/jbm.b.31973] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 05/26/2011] [Accepted: 05/31/2011] [Indexed: 01/05/2023]
Abstract
The surgical repair of pelvic organ prolapse using synthetic mesh can fail because of slow or partial implant integration due to poor biocompatibility or infection. As systemic antibiotic prophylaxis has only limited success, we have developed a system that coats standard polypropylene mesh with clinically relevant antibiotics. Amoxicillin and ofloxacin are both released from the mesh in vitro at high levels over 3 days, preventing adhesion and biofilm formation by a clinical isolate of E. coli. In an in vivo incisional hernia repair model in rats, the antibiotic-coated mesh results in appropriate tissue integration with adequate vascularization and collagen formation. When implanted animals are infected with virulent E. coli, both antibiotic coatings provide full protection against infection (as assessed both clinically and microbiologically), thus demonstrating their bioavailability. This method is a specific approach for producing a therapeutic coating that could reduce postsurgical infections.
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Affiliation(s)
- Vincent Letouzey
- Department of Gynecology and Obstetrics, Caremeau University Hospital, Place Pr R Debré, 30000 Nimes, France; Max Mousseron Institute of Biomolecules, UMR CNRS 5247, Universities Montpellier 1 and Montpellier 2, Faculty of Pharmacy, 15 Avenue Charles Flahault, BP 14491, 34093 Montpellier, France.
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Kuehn C, Graf K, Mashaqi B, Pichlmaier M, Heuer W, Hilfiker A, Stiesch M, Chaberny IF, Haverich A. Prevention of early vascular graft infection using regional antibiotic release. J Surg Res 2010; 164:e185-91. [PMID: 20828762 DOI: 10.1016/j.jss.2010.05.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 04/16/2010] [Accepted: 05/13/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Infections after prosthetic replacement of the aorta remain a serious and life-threatening complication. The only appropriate treatment is the surgical removal of the infected prosthesis. Accordingly, there is a need for new procedures to prevent the infection of vascular prostheses. This in vitro experiment investigated the effect of the pretreatment of vascular prostheses with antibiotics (daptomycin or baneocin) and the effect of antibiotics combined with fibrin sealant as possible prophylaxis of perioperative graft infection. METHODS Untreated prostheses served as controls. Pretreated prostheses of double woven velour vascular grafts were contaminated with Staphylococcus epidermidis, and colony-forming units were counted each day (CFU/mL). RESULTS The period of sterility differed significantly as a function of the pretreatment. Uncoated prostheses were immediately non-sterile and exhibited 2.63 ± 0.61 × 10(5) CFU/mL. Baneocin pretreatment resulted in sterility for 1.7 ± 0.6 (95% confidence interval (CI) 1.0-2.4) d before we detected 2.14 ± 0.57 × 10(5) CFU/mL on the prostheses. Pretreatment with daptomycin yielded 2.9 ± 0.4 (CI 2.6-3.2) and fibrin sealant/baneocin compound yielded 3.1 ± 0.3 (CI 2.9-3.3) d of sterility, after which 1.81 ± 0.86 × 10(5) CFU/mL and 1.04 ± 0.77 × 10(5) CFU/mL were recorded. Finally, pretreatment with fibrin sealant/daptomycin led to sterility for 7.1 ± 0.3 (CI 6.9-7.3) d, after which 0.77 ± 0.60 × 10(5) CFU/mL were observed on the prostheses. CONCLUSIONS The risk of vascular graft infection is reduced by pretreating the prostheses with antibiotics. The antibiotic/fibrin compound exhibited an effect of delayed antibiotic release. Vascular prostheses should therefore be pretreated with antibiotic solution to reduce bacterial adhesion. This procedure might be an effective prophylaxis for perioperative vascular graft infection and provides suitable protection for the prosthetic material.
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Affiliation(s)
- Christian Kuehn
- Department of Thoracic, Transplant, and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
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10
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The management of aortic stent-graft infection: endograft removal versus conservative treatment. Ann Vasc Surg 2010; 24:554.e1-5. [PMID: 20097522 DOI: 10.1016/j.avsg.2009.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Revised: 10/18/2009] [Accepted: 11/09/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully. METHODS Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal. RESULTS Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection. CONCLUSION Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.
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Piterina AV, Cloonan AJ, Meaney CL, Davis LM, Callanan A, Walsh MT, McGloughlin TM. ECM-based materials in cardiovascular applications: Inherent healing potential and augmentation of native regenerative processes. Int J Mol Sci 2009; 10:4375-4417. [PMID: 20057951 PMCID: PMC2790114 DOI: 10.3390/ijms10104375] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2009] [Revised: 09/07/2009] [Accepted: 09/30/2009] [Indexed: 01/21/2023] Open
Abstract
The in vivo healing process of vascular grafts involves the interaction of many contributing factors. The ability of vascular grafts to provide an environment which allows successful accomplishment of this process is extremely difficult. Poor endothelisation, inflammation, infection, occlusion, thrombosis, hyperplasia and pseudoaneurysms are common issues with synthetic grafts in vivo. Advanced materials composed of decellularised extracellular matrices (ECM) have been shown to promote the healing process via modulation of the host immune response, resistance to bacterial infections, allowing re-innervation and reestablishing homeostasis in the healing region. The physiological balance within the newly developed vascular tissue is maintained via the recreation of correct biorheology and mechanotransduction factors including host immune response, infection control, homing and the attraction of progenitor cells and infiltration by host tissue. Here, we review the progress in this tissue engineering approach, the enhancement potential of ECM materials and future prospects to reach the clinical environment.
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Affiliation(s)
- Anna V. Piterina
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Aidan J. Cloonan
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Claire L. Meaney
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Laura M. Davis
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Anthony Callanan
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Michael T. Walsh
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
| | - Tim M. McGloughlin
- Centre for Applied Biomedical Engineering Research (CABER), Department of Mechanical & Aeronautical Engineering, and Materials and Surface Science Institute (MSSI), University of Limerick, Limerick, Ireland; E-Mails:
(A.V.P.);
(A.J.C.);
(C.L.M.);
(L.M.D.);
(A.C.);
(M.T.W.)
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HANSEN LINDAK, BROWN MARY, JOHNSON DAVID, PALME II DONALDF, LOVE CHARLES, DAROUICHE RABIH. In VivoModel of Human Pathogen Infection and Demonstration of Efficacy by an Antimicrobial Pouch for Pacing Devices. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:898-907. [DOI: 10.1111/j.1540-8159.2009.02406.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Comparative efficacies of telavancin and vancomycin in preventing device-associated colonization and infection by Staphylococcus aureus in rabbits. Antimicrob Agents Chemother 2009; 53:2626-8. [PMID: 19364874 DOI: 10.1128/aac.01101-08] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Telavancin is an investigational lipoglycopeptide antibiotic that is active against gram-positive pathogens. In an in vivo rabbit model, subtherapeutic (15-mg/kg) and therapeutic (30- or 45-mg/kg) doses of telavancin were demonstrated to be noninferior and superior to vancomycin (20 mg/kg), respectively, for preventing subcutaneous implant colonization and infection by Staphylococcus aureus.
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14
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Comparative assessment of antimicrobial activities of antibiotic-treated penile prostheses. Eur Urol 2008; 56:1039-45. [PMID: 19135292 DOI: 10.1016/j.eururo.2008.12.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 12/17/2008] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although infections associated with penile implants are relatively infrequent, they result in serious medical consequences. Because treatment of these infections usually requires removal of the infected penile implant, prevention of infection is crucial. Since bacterial colonization of the implant is a prelude to clinical infection, antimicrobial modification of the devices may inhibit device colonization and subsequent infection. OBJECTIVE We compared the spectrum and durability, both in vitro and in vivo, of two antibiotic-treated penile prostheses: InhibiZone implants pre-impregnated with minocycline and rifampin (M/R) and Titan implants dipped in vancomycin. DESIGN, SETTING, AND PARTICIPANTS 1×1-cm cylinder segments of (1) control untreated, (2) M/R-impregnated, and (3) vancomycin-dipped implants were studied. Baseline zones of inhibition (ZI) were determined against clinical isolates, including methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant S. epidermidis (MRSE), vancomycin-resistant Enterococcus (VRE), and Escherichia coli. In addition, ZI against methicillin-susceptible S. aureus were compared both in vitro after being washed in a flow chamber and after subcutaneous implantation in rabbits for 1, 2, 7, and 14 d. MEASUREMENTS ZI were measured as the diameter of the clear zone around each test device minus the external diameter of the device. RESULTS AND LIMITATIONS Implants pre-impregnated with M/R displayed a broader spectrum of antimicrobial activity than vancomycin-dipped implants against both gram-positive and -negative bacteria. The M/R-impregnated devices also yielded significantly larger zones of inhibition against S. aureus than vancomycin-dipped implants, both in vitro (p<0.003) and in vivo throughout the 14-d period of device implantation in rabbits (p≤0.03). CONCLUSIONS Penile prostheses impregnated with M/R have a broader spectrum in vitro and a more durable antimicrobial activity in vitro and in an animal model than implants dipped in vancomycin. Therefore, along with being a more practical model for incorporating antimicrobials onto the device, the use of implants pre-impregnated with M/R may help reduce the incidence of penile implant infection.
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Fischer PE, Fabian TC, Derijk WG, Edwards NM, Decuypere M, Landis RM, Barnard DL, Magnotti LJ, Croce MA. Prosthetic Vascular Conduit in Contaminated Fields: A New Technology to Decrease ePTFE Infections. Am Surg 2008. [DOI: 10.1177/000313480807400611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular reconstruction using prosthetic materials in contaminated fields can lead to infection, graft loss, and subsequent amputation. We hypothesized that minocycline and rifampin bound to an ePTFE graft using a unique methacrylate technology would provide for resistance from infection and controlled antibiotic elution. Kirby Bauer susceptibility testing was performed on plates overlaid with Staph aureus (SA) and Staph epidermidis (SE) using 6 mm diameter discs of uncoated graft or antibiotic coated graft (ABX). Zones of inhibition (ZIH) were determined after 24 hours. ABX grafts were then placed in a continuous water bath and a recirculating, pulsatile flow device. Susceptibility testing and high performance liquid chromatography with mass spectroscopy was performed to determine graft performance and antibiotic elution rate. ABX grafts had an average ZIH of 35 mm for SA and 44 mm for SE (each P < 0.0001). After the 1 week water bath, the ZIH of the ABX grafts was 23 mm on both the SA and SE plates. The high performance liquid chromatography with mass spectroscopy revealed that after 24 hours, 50 per cent of the antibiotics remained on the graft, and there was a sustained elution for 7 days. Minocycline and rifampin can be bound to ePTFE vascular grafts using a unique methacrylate method. In vitro, the grafts provide a slow elution of antibiotics that provide resistance from infection by SA and SE for up to 2 weeks after graft insertion.
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Affiliation(s)
- Peter E. Fischer
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Timothy C. Fabian
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Waldemar G. Derijk
- College of Dentistry, Biomaterials Division, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Norma M. Edwards
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Michael Decuypere
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Ryan M. Landis
- College of Engineering, Materials Science and Engineering, University of Tennessee, Knoxville, Tennessee
| | - Danielle L. Barnard
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Louis J. Magnotti
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
| | - Martin A. Croce
- College of Medicine, Department of Surgery, University of Tennessee Health Science Center, Memphis Tennessee
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Chang HI, Lau YC, Yan C, Coombes AGA. Controlled release of an antibiotic, gentamicin sulphate, from gravity spun polycaprolactone fibers. J Biomed Mater Res A 2008; 84:230-7. [PMID: 17607742 DOI: 10.1002/jbm.a.31476] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The antibiotic, gentamicin sulphate (GS), was incorporated in gravity-spun polycaprolactone (PCL) fibers by spinning from particulate suspensions of the drug in PCL solution to produce a controlled delivery system. The production rate of GS-loaded PCL fibers was confined to the range 1-1.5 m/min and the fiber diameter to 170-220 microm. The kinetics of drug release could be adjusted by varying the GS loading of the fibers and the suspension preparation conditions. Gradual release of approximately 80% of the initial GS content was measured in phosphate buffered saline at 37 degrees C over 50 days from fibers spun from nonhomogenized suspensions, whereas loss of this amount of antibiotic occurred in less than 10 days from fibers spun from homogenized suspensions. Studies of growth inhibition of Stapyhlococcus epidermidis in culture indicated that GS released after 2 weeks from PCL fibers retained antibacterial activity. This behavior recommends further investigation of PCL fibers for local delivery of antibiotics to combat infection associated with periodontal disease, musculoskeletal injuries, and implantation of fiber-based tissue substitutes such as vascular prostheses.
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Affiliation(s)
- H-I Chang
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales 2006, Australia
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Javerliat I, Goëau-Brissonnière O, Sivadon-Tardy V, Coggia M, Gaillard JL. Prevention of Staphylococcus aureus graft infection by a new gelatin-sealed vascular graft prebonded with antibiotics. J Vasc Surg 2007; 46:1026-31. [PMID: 17905555 DOI: 10.1016/j.jvs.2007.06.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 06/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of a new gelatin-sealed graft prebonded with two antibiotics in resisting infection with Staphylococcus aureus (S aureus) A980142 after direct bacterial application in a dog model. METHODS Twelve 6.0-mm polyester grafts were implanted in dogs end-to-end into the infrarenal aorta. The dogs were divided into two groups. A test group (n = 6) received experimental antibiotic-bonded gelatin-sealed knitted polyester grafts, loaded with two antibiotics, rifampin and tobramycin. A control group (n = 6) received commercial gelatin-sealed knitted polyester grafts. At the end of graft implantation, 50 mul of a 1.8 x 10(4) CFU/mL S aureus solution were instilled directly over the graft. One week after implantation, grafts were harvested with sterile technique. Quantitative cultures were obtained from all the harvested grafts. The results were expressed as colony-forming units per cm(2) of surface of the graft. Bacteriological study was also performed on various tissue samples. The chi(2) test was used to compare the culture proven infection of control and antibiotics-bonded grafts. RESULTS Mean inoculum size was similar in the two groups of dogs. Five of the six control grafts grew S aureus A980142 at the time of graft removal, whereas none of the six antibiotic-bonded gelatin-sealed grafts were infected (P = .0192). None of the organ samples were infected in the group implanted with antibiotic-bonded grafts, whereas 15/34 samples grew S. aureus in the control group. CONCLUSION These results indicate that this gelatin sealed graft prebonded with two antibiotics resists infection caused by S aureus graft contamination in a dog model.
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Affiliation(s)
- Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
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Chang HI, Perrie Y, Coombes AGA. Delivery of the antibiotic gentamicin sulphate from precipitation cast matrices of polycaprolactone. J Control Release 2006; 110:414-421. [PMID: 16325955 DOI: 10.1016/j.jconrel.2005.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 10/17/2005] [Accepted: 10/28/2005] [Indexed: 12/01/2022]
Abstract
Microporous, poly(epsilon-caprolactone) (PCL) matrices were loaded with the aminoglycoside antibiotic, gentamicin sulphate (GS) using the precipitation casting technique by suspension of powder in the PCL solution prior to casting. Improvements in drug loading from 1.8% to 6.7% w/w and distribution in the matrices were obtained by pre-cooling the suspension to 4 degrees C. Gradual release of approximately 80% of the GS content occurred over 11 weeks in PBS at 37 degrees C and low amounts of antibiotic were measured up to 20 weeks. The kinetics of release could be described effectively by the Higuchi model with the diffusion rate constant (D) increasing from of 1.7 to 5.1 microg/mg matrix/day(0.5) as the drug loading increased from 1.4% to 8.3% w/w. GS-loaded PCL matrices retained anti-bacterial activity after immersion in PBS at 37 degrees C over 14 days as demonstrated by inhibition of growth of S. epidermidis in culture. These findings recommend further investigation of precipitation-cast PCL matrices for delivery of hydrophilic molecules such as anti-bacterial agents from implanted, inserted or topical devices.
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Affiliation(s)
- H-I Chang
- Faculty of Pharmacy, University of Sydney, NSW 2006, Australia
| | - Y Perrie
- Aston Pharmacy School, Aston University, Birmingham, B4 7ET, UK
| | - A G A Coombes
- Faculty of Pharmacy, University of Sydney, NSW 2006, Australia.
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Monahan TS, Phaneuf MD, Contreras MA, Andersen ND, Popescu-Vladimir A, Bide MJ, Dempsey DJ, Mitchell RN, Hamdan AD, LoGerfo FW. In Vivo Testing of an Infection-Resistant Annuloplasty Ring. J Surg Res 2006; 130:140-5. [PMID: 16154148 DOI: 10.1016/j.jss.2005.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 05/23/2005] [Accepted: 06/05/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND An infection-resistant surface incorporated into a prosthetic cardiac valve has great potential clinical applications. STUDY DESIGN A sewing ring construct was created using ciprofloxacin-treated polyester. Then ciprofloxacin-treated and untreated constructs were implanted subcutaneously on the dorsum of rats and inoculated with Staphylococcus aureus. At 7, 14, and 30 days animals were sacrificed and the implants were retrieved. Each implant was assessed for frank purulence and gross tissue incorporation by a blinded observer. The implants were processed for conventional histology and examined by a blinded Pathologist. Ciprofloxacin-treated rings were also implanted in the absence of a bacterial challenge. At explantation, a maximal zone of inhibition, if present, was measured. Finally, ciprofloxacin was eluted with methanol from the explanted segments and the concentration of ciprofloxacin eluted was determined. RESULTS Ciprofloxacin-treated sewing rings had greater gross tissue incorporation than untreated rings in the presence of a bacterial challenge (P=0.005). Ciprofloxacin-treated rings also had a lower incidence of frank purulence, but this did not reach statistical significance. After 14 days of implantation, ciprofloxacin treated rings had fewer neutrophils (P=0.018) and greater histological tissue incorporation (P=0.017) than untreated rings. The explanted ciprofloxacin-treated rings maintained a zone of inhibition of 3.0+/-1.0 mm after 1 day of implantation and 1.3+/-0.6 mm after 2 days. Ciprofloxacin could be eluted in significant quantities from the explanted rings after 7 days of implantation. CONCLUSIONS Ciprofloxacin treated polyester can be incorporated into an annuloplasty ring construct that demonstrates excellent tissue incorporation and infection resistance. This study supports the use of this construct in the mitral position in a large animal model.
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Affiliation(s)
- Thomas S Monahan
- Department of Surgery, Division of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA.
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