Optimization of the Resistance of Arterial Allografts to Infection: Comparative Study with Synthetic Prostheses

Camiade, Christophe; Goldschmidt, Pablo; Koskas, Fabien; Ricco, Jean‐Baptiste; Jarraya, Mohamed; Gerota, J; Kieffer, Édouard

doi:10.1007/s100160010051

Cited by 40 publications

(22 citation statements)

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“…EPTFE is more hydrophobic than Dacron, perhaps that's why it is less likely to form bonds with those bacteria in which the cell walls have hydrophobic properties [19,46]. The findings of the present study was similar with previous studies reporting that S. epidermidis , S. aureus and Escherichia coli had greater affinity to Dacron graft when compared with ePTFE [19,47,48]. The bacterial count in the untreated contaminated ePTFE grafts was very low than the untreated contaminated Dacron groups.…”

Section: Discussionsupporting

confidence: 87%

Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidisgraft infection

et al. 2005

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BackgroundThe aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials.MethodsGraft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 107 CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture.ResultsThere was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05).ConclusionThe study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance.

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Section: Discussionsupporting

confidence: 87%

Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidisgraft infection

et al. 2005

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“…Different antimicrobial agents have been used (3,5), as well as different ways to bind those drugs onto the surface of a PTFE prosthesis.…”

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confidence: 99%

New Anti-Infective Coatings of Medical Implants

Matl

Obermeier

Repmann³

et al. 2008

Antimicrob Agents Chemother

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Implantable devices are highly susceptible to infection and are therefore a major risk in surgery. The present work presents a novel strategy to prevent the formation of a biofilm on polytetrafluoroethylene (PTFE) grafts. PTFE grafts were coated with gentamicin and teicoplanin incorporated into different lipid-like carriers under aseptic conditions in a dipping process. Poly-D,L-lactic acid, tocopherol acetate, the diglyceride Softisan 649, and the triglyceride Dynasan 118 were used as drug carriers. The drug release kinetics, anti-infective characteristics, biocompatibility, and hemocompatibility of the coatings developed were studied. All coatings showed an initial drug burst, followed by a low continuous drug release over 96 h. The dimension of release kinetics depended on the carrier used. All coated prostheses reduced bacterial growth drastically over 24 h, even below pathologically relevant concentrations. Different cytotoxic levels could be observed, revealing tocopherol acetate as the most promising biocompatible carrier. A possible reason for the highly cytotoxic effect of Softisan 649 could be assessed by demonstrating incorporated lipids in the cell soma with Oil Red O staining. Tromboelastography studies, enzyme-linked immunosorbent assays, and an amidolytic substrate assay could confirm the hemocompatibility of individual coatings. The development of the biodegradable drug delivery systems described here and in vitro studies of those systems highlight the most important requirements for effective as well as compatible anti-infective coatings of PTFE grafts. Through continuous local release, high drug levels can be produced at only the targeted area and physiological bacterial proliferation can be completely inhibited, while biocompatibility as well as hemocompatibility can be ensured.A major risk associated with surgical placement of medical implants such as endoprostheses or vascular prostheses is their high infection rate (4,8). This is not only of prime importance for the patient but also imposes a high financial cost on the economy (21). Synthetic vascular grafts such as polytetrafluoroethylene (PTFE) prostheses are easily accessible to pathogens, mostly Staphylococcus aureus and Staphylococcus epidermidis. These pathogens colonize the implant by adhering to the patient's own proteins located on the surface of the graft and form a biofilm (1,14,16,23,34). The formation of biofilms on biomaterials presents challenging complications in the field of medical implants (2,12,24,28,30). In a biofilm, bacteria are well protected from the host immune defense. An increase in antibiotic resistance is the consequence (6,8,35); even high local concentrations of antibiotics do not completely eradicate bacteria in biofilms (8, 10). It is therefore of great importance to prevent bacterial adhesion on vascular grafts (7). This can be achieved by antibiotic surface coatings.There have been several approaches to equipping vascular grafts with anti-infective agents to prevent bacterial colonization. Different antim...

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“…En pacientes inmunodeprimidos y en pacientes con aneurismas aórticos micóticos o infectados existe un alto riesgo de infección protésica (168) , por lo que en estos el tratamiento estándar mediante prótesis está contraindicado. En estos casos el uso de homoinjertos arteriales criopreservados es una alternativa terapéutica (33,168) . En la actualidad está bien fundamentado que los materiales biológicos tienen más alta resistencia a la infección que las prótesis sintéticas (231,70,33,10) .…”

Section: -2-2 Trasplantes Homoplásticosunclassified

“…En estos casos el uso de homoinjertos arteriales criopreservados es una alternativa terapéutica (33,168) . En la actualidad está bien fundamentado que los materiales biológicos tienen más alta resistencia a la infección que las prótesis sintéticas (231,70,33,10) .…”

Section: -2-2 Trasplantes Homoplásticosunclassified

“…La patogénesis de la infección del injerto vascular es probable que sea multifactorial, influyendo en el riesgo de infección del injerto factores tales como el tipo de material de injerto (10) , el método de fabricación del injerto (243) , el lugar del implante, el tiempo de duración de la operación, el uso de profilaxis antibiótica, defensas y estado nutricional del paciente, presencia de infección remota y patogenicidad de organismos contaminantes (134,33,241) .…”

Section: Importancia De La Composición Y Fabricación Del Injertounclassified

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Respuesta inflamatoria y cirugía protésica. Su control con donadores de óxido nítrico

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Optimization of the Resistance of Arterial Allografts to Infection: Comparative Study with Synthetic Prostheses

Cited by 40 publications

References 19 publications

Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidisgraft infection

Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidisgraft infection

New Anti-Infective Coatings of Medical Implants

Respuesta inflamatoria y cirugía protésica. Su control con donadores de óxido nítrico

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