Diagnostic imaging techniques in vascular graft infection

Infections in vascular surgery

Infections in vascular surgery are usually of multifactorial nature resulting from a complex interplay of patient, surgical and environmental factors. Preventative measures initiated from the stage of pre-operative screening, maintenance of patient homeostasis and the use of organism-directed antibiotics can contribute to reduce infection rates. Graft preservation techniques are becoming increasingly popular as a method to treat established graft infections. In this article we report on the current trends and techniques on the management of infections in vascular surgery. Ongoing studies are required to continue to accumulate data on the effectiveness of these techniques.

Rifampin and Triclosan but not silver is effective in preventing bacterial infection of vascular dacron graft material

OBJECTIVES

To evaluate the efficacy of silver- or Triclosan-coated prosthetic material compared to Rifampin bonded Dacron concerning their resistance to infection following subcutaneous implantation and contamination with Staphylococcus aureus.

DESIGN

Animal experimental study in mice.

MATERIAL AND METHODS

Thirty-six C3H/HcN mice (Charles River Lab., Sulzfeld, Germany) with a weight between 24 and 27 g were randomised into six groups counting six animals each. Group I: control, gel-sealed dacron graft, group II: gel-sealed dacron graft and local contamination, group III: Intergard-Silver-prosthesis and contamination, group IV: silver/gel-sealed dacron prosthesis (test graft) and contamination, group V: Rifampin-bonded gel-sealed graft and contamination, group VI: Triclosan/collagen-coated dacron graft and contamination. Dacron graft material 0.8x1 cm was subcutaneously implanted in mice. Local contamination with 2x10(7)/0.2 ml S. aureus ATCC 25923 was carried out in groups II to VI. On day 14 the animals were killed and the grafts were explanted. The microscopic, histologic and microbiological evaluation of the graft material and the perigraft tissue was performed.

RESULTS

In control group I no case of infection was detected. In group II, 6 of 6 animals showed infection. In group III (Intergard-Silver) and group IV (silver/gel-test graft) were 6 of 6, in group V (Rifampin) only 1 of 6 grafts and in group VI (Triclosan) 4 of 6 grafts were infected. The difference between the low rate of infection in group V (Rifampin) in comparison to the completely infected groups III and IV (Silver) as well as the control group II was significant. Treatment of grafts with Triclosan could prevent infection only in 1/3 of the cases in group IV.

CONCLUSION

Silver coating failed to prevent graft infection material. A potential antimicrobial property was evident for Triclosan whereas Rifampin-bonded grafts exhibit a significantly reduced infection rate. Thus, silver-coated vascular grafts cannot ensure protection from vascular graft infection.

The prevention and treatment of vascular graft infection with a Triclosan (Irgasan)-bonded Dacron graft: an experimental study in the pig

OBJECTIVES

to evaluate the role of Triclosan (Irgasan(R)) in the prevention of prosthetic graft infection.

MATERIAL AND METHODS

fifty-one pigs were assigned randomly to six groups. Group I (graft) and II (graft and Triclosan) were control groups. Groups III (graft) and IV (grafts and Triclosan) were contaminated with 2 x 10(7)CFU/ml S. aureus. Groups V (graft) and VI (graft and Triclosan) were intraoperatively contaminated with 2 x 10(7)CFU/ml S. aureus and reoperated on after 7 days. Remaining animals were sacrificed on day 28. The end point of the investigation was vascular graft infection, defined as the bacteriological and/or histological proof of infection. Results in both control groups no vascular graft infections were detected in Groups I and II. All of the group III animals presented but none of the group IV developed a graft infection (p <0.02). All of the group V animals presented and 10 of 12 animals developed a graft infection.

CONCLUSION

in this animal model Triclosan bonding appears effective in preventing prosthetic graft infection. However, the in situ replacement of Triclosan-protected grafts was not successful in the treatment of graft infection.

Binding kinetics of triclosan (Irgasan) to alloplastic vascular grafts: an in vitro study

The aim of this study was to investigate the binding kinetics of triclosan (Irgasan) to alloplastic vascular grafts and to examine its antimicrobial activity against various microbial pathogens in vitro. Vascular grafts made by Intergard (Intervascular), Fluoropassiv (Vascutek), and Gore-tex (Gore) were examined. Grafts were incubated in 10 g/L triclosan (Irgasan), dried, sterilized, and incubated in RPMI medium. One-centimeter segments of the grafts were resected under sterile conditions at intervals of minutes, then hours, followed by days and up to 4 weeks. Samples were stored frozen at -20 degrees C for the measurement of triclosan bound to the vascular graft by high-performance liquid chromatography (HPLC). The binding kinetics under perfusion conditions were determined for Intergard grafts, which were perfused with 50 mL of nutrient medium for 24 hr. Samples were taken at various time intervals for the measurement of triclosan. The antimicrobial activity of triclosan against Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans as well as Enterococcus faecium was determined. Triclosan effectively binds to vascular graft without the use of intermediate binding substances. It stayed on the graft for the duration of 4 weeks. Under both static and perfusion conditions, the binding kinetics are similar. Triclosan binds most effectively to Intergard grafts, less so to Fluoropassiv grafts, and not at all to Gore-tex material. Antimicrobial activity of triclosan is very effective against S. aureus and E. faecium but not against P. aeruginosa.