In vitro efficacy of antibiotic beads in treating abdominal vascular graft infections

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• 作者：Kristofer M. Charlton-Ouw ; MD ; FACS^a ; ^b ; ^{kristofer.charltonouw@uth.tmc.edu" class="auth_mail" title="E-mail the corresponding author} ; Fernando Kubrusly ; MD^a ; Harleen K. Sandhu ; MD ; MPH^a ; Michelle C. Swick ; PhD^c ; Samuel S. Leake ; BS^a ; Brian E. Gulbis ; PharmD^b ; Theresa M. Koehler ; PhD^c ; Hazim J. Safi ; MD ; FACS^a ; ^b
• 刊名：Journal of Vascular Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：62
• 期：4
• 页码：1048-1053
• 全文大小：773 K

文摘

Abdominal aortic vascular graft infection often involves several different organisms. Antibiotic polymethyl methacrylate (PMMA) beads may be effective in controlling infection after débridement, but bacterial species identification and antibiotic susceptibility are often not available at the time of operation, generating a need for a broad-spectrum drug combination for empirical use. We sought to determine an effective antibiotic in PMMA beads for use in abdominal vascular graft infection.

Methods

PMMA beads were impregnated with combinations of antibiotics, consisting of daptomycin, tobramycin, and meropenem. Antibiotics were selected on the basis of activity spectrum and heat stability. Beads were placed on separate agar plates with vancomycin-resistant Enterococcus faecalis, Klebsiella pneumoniae, Staphylococcus epidermidis, and methicillin-resistant Staphylococcus aureus. Antibiotic inhibition was recorded by use of a modified agar-based disk-diffusion method.

Results

Daptomycin alone was not active against K. pneumoniae (average = 0 mm). Tobramycin alone was not active against vancomycin-resistant E. faecalis, K. pneumoniae, or methicillin-resistant S. aureus. Tobramycin and daptomycin in combination had moderate broad-spectrum activity with 8- to 14-mm mean inhibition halos. Meropenem showed strong activity against all tested organisms with >15-mm mean inhibition halos. The addition of daptomycin to meropenem provided improved coverage of gram-positive organisms. The presence of tobramycin reduced the efficacy of meropenem.

Conclusions

Antibiotic PMMA beads containing 10% meropenem with 2.5% daptomycin had excellent in vitro activity against typical bacterial species associated with abdominal vascular graft infections. The addition of antibiotic beads may be a useful adjunct in managing such cases. Further studies are required to determine efficacy in clinical practice.