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Local treatment of prosthetic vascular graft infection with multivesicular liposome-encapsulated amikacin
1Department of Surgery, Veterans Administration Medical Center, Long Beach, California, USA.
Background:
Contaminated surgical fields limit the use of prosthetic vascular grafts. We studied the efficacy of sustained-release amikacin applied locally to contaminated grafts in the prevention of infectious complications.
Materials And Methods:
Thirty-one New Zealand white rabbits underwent placement of a polytetrafluoroethylene (PTFE) interposition graft in a 1-cm segment of the descending aorta. The surgical field was infected with application of 10(5) to 10(8) Staphylococcus aureus organisms suspended in normal saline solution. Nineteen rabbits underwent contaminated aortic graft placement without treatment. Twelve rabbits were treated with local application of 2.5 ml of amikacin encapsulated in lipid particle-based sustained-release dosage form. Rabbits were observed for 2 weeks and then evaluated for the presence of graft infection.
Results:
Seventy-five percent of the treated rabbits survived without evidence of graft infection or systemic sepsis versus 37% in the untreated group (P < 0.04). Cultures verified the absence of organisms in all surviving rabbits without clinical infection.
Conclusions:
Sustained-release lipid particle-encapsulated amikacin applied to contaminated PTFE grafts increased survival and decreased postoperative graft infections. Adjunctive use of local, delayed-release antibiotics in contaminated vascular beds may allow wider clinical use of prosthetic grafts.
Insights
Local amikacin delivery prevents infection in contaminated vascular grafts. Sustained-release amikacin in lipid particles significantly increased survival and reduced graft infections in rabbits.
Area of Science:
- Biomedical Engineering
- Infectious Disease Research
- Vascular Surgery
Background:
- Prosthetic vascular graft use is limited by contamination risks in surgical fields.
- Infectious complications pose a significant threat to graft patency and patient outcomes.
- Novel strategies are needed to mitigate infection risk in contaminated surgical sites.
Purpose of the Study:
- To evaluate the efficacy of locally applied, sustained-release amikacin in preventing infectious complications associated with contaminated prosthetic vascular grafts.
- To determine if amikacin encapsulated in lipid particles can reduce graft infection rates in a rabbit model.
Main Methods:
- Polytetrafluoroethylene (PTFE) interposition grafts were placed in the descending aorta of 31 New Zealand white rabbits.
- Surgical fields were contaminated with Staphylococcus aureus (10^5–10^8 organisms).
- Rabbits received either no treatment (n=19) or local amikacin delivered via lipid particle-based sustained-release form (n=12).
Main Results:
- The treated group showed a 75% survival rate without graft infection or sepsis, compared to 37% in the untreated group (P < 0.04).
- Cultures confirmed the absence of Staphylococcus aureus in all surviving, clinically uninfected rabbits.
- Local amikacin application significantly reduced the incidence of postoperative graft infections.
Conclusions:
- Sustained-release amikacin delivered via lipid particles effectively prevents infection in contaminated PTFE vascular grafts.
- This localized antibiotic delivery method enhances survival and decreases graft infections.
- Local, delayed-release antibiotics hold promise for expanding the use of prosthetic grafts in contaminated surgical settings.