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J Thorac Cardiovasc Surg 2008;135:25-31
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Less-invasive and highly effective method for preventing methicillin-resistant Staphylococcus aureus graft infection by local sustained release of vancomycin

Hisashi Sakaguchi, MDa, Akira Marui, MD, PhDa, Keiichi Hirose, MD, PhDa, Takamasa Nomura, PhDb, Yoshio Arai, MD, PhDa, Shyamal Chandra Bir, MDa, Yuhong Huang, MDa, Jiro Esaki, MDa, Yasuhiko Tabata, PhD, DMSc, Dpharmc, Tadashi Ikeda, MD, PhDa, Masashi Komeda, MD, PhDa,*

a Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
b Department of Microbiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
c The Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan.

Received for publication February 28, 2007; revisions received May 12, 2007; accepted for publication June 20, 2007.

* Address for reprints: Masashi Komeda, MD, PhD, Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507 Japan. (Email: komelab{at}kuhp.kyoto-u.ac.jp).

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 mm2) was sutured at the anterior wall of the incised murine abdominal aorta. Methicillin-resistant S aureus (1.0 x 103 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.

Abbreviations and Acronyms CFU = colony-forming units; MIC = minimum inhibitory concentration; MRSA = methicillin-resistant Staphylococcus aureus ; PLCA = poly-L-lactide-co-caprolactone




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