Related Experiment Videos
Gentamicin beads in vascular surgery: long-term results of implantation
P J Benaerts1, B M Ridler, P Vercaeren
1Department of Surgery, Royal Devon and Exeter Hospital, UK.
Abstract:
The authors conducted a prospective study, with a subsequent review of case-notes and follow-up of patients, to review the results of insertion of gentamicin beads for the prevention and treatment of infection in vascular surgery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15 and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were followed up for 1-44 months (median 15) later. There was no further infection at 60% of the sites where gentamicin beads were used to treat proven graft sepsis, and 50% of sites in various sinuses. Infection developed at 16% of the sites where gentamicin beads were used prophylactically. Adverse effects were observed in three cases of long-term implantation: one chain of beads caused discomfort that required removal, the skin failed to heal over one chain, and one may possibly have caused a bypass graft to kink and occlude. In conclusion, gentamicin beads are a useful adjunct in the management of vascular graft infection and in prophylaxis for some high risk cases. Chains of beads can be implanted long term with few adverse sequelae.
Insights
Gentamicin beads effectively treat vascular graft infections and prevent sepsis in high-risk patients. Long-term implantation of these antibiotic beads shows few adverse effects, making them a valuable surgical adjunct.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Biomaterials in Medicine
Background:
- Vascular graft infections pose significant challenges, increasing morbidity and mortality.
- Effective prevention and treatment strategies are crucial for improving patient outcomes.
- Gentamicin beads offer localized antibiotic delivery, potentially enhancing efficacy and reducing systemic toxicity.
Purpose of the Study:
- To evaluate the efficacy and safety of gentamicin beads for preventing and treating vascular surgery infections.
- To assess the outcomes of permanently implanted gentamicin bead chains.
- To determine the incidence of infection and adverse events associated with gentamicin bead use.
Main Methods:
- Prospective study involving 35 patients and 62 treatment sites.
- Gentamicin beads used for treatment of graft sepsis, sinus infections, and prophylactic purposes.
- Follow-up of patients with permanently implanted bead chains for 1-44 months.
Main Results:
- No further infection at 60% of sites treated for graft sepsis and 50% of sinus sites.
- Prophylactic use resulted in infection at 16% of sites.
- Three adverse events reported with long-term implantation, including discomfort, delayed skin healing, and graft kinking.
Conclusions:
- Gentamicin beads are a valuable adjunct for managing vascular graft infections.
- Prophylactic use is beneficial in select high-risk cases.
- Permanent implantation of gentamicin bead chains is associated with few long-term adverse sequelae.