Background and objectives: Treatment of a prosthetic vascular graft infection (PVGI) remains a challenging problem in vascular surgery. The aim of this study was to design a novel rat model for treatment of peripheral vascular prosthesis infection caused by Staphylococcus aureus (S. aureus) and to determine the efficacy of different antiseptic solutions in suppressing or eradicating infection from the wound and the graft material itself. Materials and methods: A piece of Dacron vascular prosthesis was surgically implanted at the dorsum of 48 Wistar rats and the wounds were infected with 5 McFarland standard inoculum of S. aureus. Suppurating wounds were daily irrigated with different antiseptic solutions: octenidine dihydrochloride, povidone-iodine, chlorhexidine digluconate, and sterile saline. The antimicrobial action of antiseptics was defined according to their capability to eradicate bacteria from the graft surroundings and bacteriological examination of the graft itself. Extended studies on wound microbiology, cytology, and histopathology were performed with an additional group of 10 rats, treated with the most effective antiseptic-octenidine dihydrochloride. Results: Four-day treatment course with octenidine, povidone-iodine, and chlorhexidine resulted in 99.98% (p = 0.0005), 90.73% (p = 0.002), and 65.97% (p = 0.004) decrease in S. aureus colonies in wound washouts, respectively. The number of S. aureus colonies increased insignificantly by 19.72% (p = 0.765) in control group. Seven-day treatment course with octenidine eradicated viable bacteria from nine out of 10 wound washouts and sterilized one vascular graft. Conclusions: A reproducible rat model of PVGI with a thriving S. aureus infection was designed. It is a first PVGI animal model where different antiseptic solutions were applied as daily irrigations to treat peripheral PVGI. Seven-day treatment with octenidine eradicated bacteria from the wound washouts for 90% of rats and one vascular graft. Further studies are needed to investigate if irrigations with octenidine could properly cure vascular bed from infection to assure a successful implantation of a new synthetic vascular substitute.
SANTRAUKAReikšminiai žodžiai: mikotinė aneurizma, infekcinė aneurizma, bakterinė infekcija, endovaskulinis gydymas, chirurginis gydymas. Mikotinė aneurizma -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotinės aneurizmos sudaro 1,3-2,3 proc. visų arterinių aneurizmų. Dažniausiai pažeidžiamos pilvo aorta ir šlaunies arterija. Mikotinės aneurizmos atsiranda dėl greta arterijos esančio septinio židinio, septinės embolijos, taip pat dėl septicemijos metu į arterijos sienelę patekusio infekcijos sukėlėjo. Predisponuojantys veiksniai tokiai aneurizmai atsirasti: cukrinis diabetas, rūkymas, šeiminė mikotinių aneurizmų anamnezė, imunosupresantų vartojimas, inkstų nepakankamumas. Mikotinių aneurizmų prognozė paprastai būna bloga, nes tokios aneurizmos linkusios greitai augti ir plyšti. Dažniausia mirties priežastis -sepsis. Diagnozei nustatyti svarbi echoskopija ir kompiuterinė tomografija. Gydymas susideda iš aneurizmos rekonstrukcijos (chirurginiu arba endovaskuliniu būdu) ir antibiotikų terapijos. Dėl gana nedidelio paplitimo mikotinių aneurizmų problema tebėra mažai tyrinėta. Šiame straipsnyje aptariami diskusiniai klausimai ir gydymo perspektyvos remiantis naujausia moksline literatūra. ABSTRACTKey words: mycotic aneurysm, infectious aneurysm, bacterial infection, endovascular repair, open repair. Mycotic aneurysm is an aneurysm with microbiologically confirmed infection of the arterial wall. It is a rather uncommon, though life-threatening disease, which makes up only 1.3-2.3 % of all the aneurysms. Mycotic aneurysms most commonly manifest in abdominal aorta and iliac artery. Mycotic aneurysms may form in the presence of adjacent infection (for example, an abscess), septic embolism or arise due to contamination of the arterial wall during septicemia. Predisposing factors are diabetes, smoking, immunosuppression, renal failure and positive family history. Main diagnostic tools are ultrasound and computer tomography. Patients with mycotic aneurysms usually have poor prognosis because these aneurysms have a tendency to enlarge and rupture. Most common cause of death is sepsis. Treatment of mycotic aneurysm involves the repair of the aneurysm (either surgically or endovasculary) and antibiotic therapy. Due to relatively low prevalence of mycotic aneurysms many questions concerning best treatment option remain unanswered. This article reviews newest scientific articles on mycotic aneurysms and discusses treatment alternatives. ĮVADASMikotinė aneurizma (MA) -tai aneurizma su mikrobiologiškai patvirtinta infekcija arterijos sienelėje. Mikotines aneurizmas, kaip infekcinio endokardito (IE) komplikaciją, pirmą kartą aprašė seras Williamas Osleris 1851 m. Terminas "mikotinė aneurizma" dėl asociacijos su grybeline infekcija iki šių dienų neretai klaidina įvairių medicinos sričių specialistus, kadangi grybelinė infekcija niekada nebuvo pagrindinis MA sukėlėjas [1]. Pastarojo dešimtmečio literatūros šaltiniuose terminas "mikotinė aneurizma" vartojamas aprašant bet kokią aneurizmą, kuri išs...
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