The clinical use of an antibiotic-bonded graft

Attempts to produce an antibiotic-bonded prosthesis have failed owing to poor binding, drug toxicity or inadequate antimicrobial activity of the antibiotic particularly against Staphylococcus epidermidis. Rifampicin, with an ideal spectrum, but untested against slime-forming S. epidermidis has recently been shown to bind with carboxyl groups on gelatin-sealed Dacron. We therefore investigated rifampicin activity against 30 slime-forming adherent S. epidermidis colonies, isolated from 40 consecutive aortic graft recipients, and compared it with their methicillin, gentamicin, cefuroxime, tetracycline and vancomycin resistance patterns. The S. epidermidis colonies were highly sensitive to very low levels of rifampicin. Rifampicin was then bonded to gelatin-sealed Dacron aortic prostheses which were inserted in four patients at high risk of developing subsequent infection.