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Prophylaxis against Staphylococcus aureus vascular graft infection with mupirocin-soaked, collagen-sealed dacron
R Ghiselli1, A Giacometti, L Goffi
1Department of General Surgery, INRCA IRRCS, University of Ancona, Ancona, Italy.
Abstract:
A rat model was used to investigate the efficacy of mupirocin in the prevention of vascular prosthetic graft infections. The effect of mupirocin-soaked Dacron was compared with the effect of rifampin-soaked, collagen-sealed Dacron in the rat model of graft infection caused by methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus. Graft infections were established in the back subcutaneous tissue of 195 adult male Wistar rats by implantation of 1-cm(2) Dacron prostheses followed by topical inoculation with 5 x 10(7) colony-forming units of S. aureus. The study included a control group (no graft contamination), two contaminated groups that did not receive any antibiotic prophylaxis, two contaminated groups in which perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg) was administered, four contaminated groups that received mupirocin- or rifampin-soaked graft, and four contaminated groups that received mupirocin- or rifampin-soaked graft and perioperative intraperitoneal amoxicillin clavulanate prophylaxis (50 mg/kg). The grafts were sterilely removed 7 days after implantation and the infection was evaluated by using sonication and quantitative agar culture. Data analysis showed that the efficacy of mupirocin against both strains was significantly different from that of the untreated control. In addition, mupirocin was more effective than rifampin against the methicillin-resistant strain. Finally, only the combination of mupirocin and amoxicillin clavulanate produced complete suppression of growth of all strains.
Insights
Mupirocin effectively prevents vascular graft infections in rats, outperforming rifampin against resistant strains. Combining mupirocin with amoxicillin clavulanate achieved complete infection suppression.
Area of Science:
- Infectious Diseases
- Surgical Innovation
- Pharmacology
Background:
- Vascular prosthetic graft infections pose significant clinical challenges.
- Methicillin-resistant Staphylococcus aureus (MRSA) presents a growing threat in surgical site infections.
- Novel prophylactic strategies are crucial for preventing graft complications.
Purpose of the Study:
- To evaluate the efficacy of mupirocin-soaked Dacron grafts in preventing Staphylococcus aureus infections.
- To compare mupirocin with rifampin-soaked grafts against both susceptible and resistant S. aureus strains.
- To assess the synergistic effect of antibiotic prophylaxis with antibiotic-soaked grafts.
Main Methods:
- A rat model of subcutaneous Dacron graft infection was established using S. aureus.
- Mupirocin- and rifampin-soaked grafts were compared to controls and antibiotic prophylaxis groups.
- Graft infection was evaluated via sonication and quantitative agar cultures 7 days post-implantation.
Main Results:
- Mupirocin demonstrated significant efficacy in preventing graft infections compared to untreated controls.
- Mupirocin showed superior effectiveness against methicillin-resistant S. aureus compared to rifampin.
- Complete suppression of all S. aureus strains was achieved only with the combination of mupirocin and amoxicillin clavulanate.
Conclusions:
- Mupirocin-soaked grafts are a promising strategy for preventing vascular prosthetic graft infections.
- Combination therapy with mupirocin and systemic antibiotics offers the highest level of protection.
- Further clinical investigation is warranted to translate these findings to human patients.