Infection prevention using affinity polymer-coated, synthetic meshes in a pig hernia model.

Autor: Blatnik JA; Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Thatiparti TR; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio., Krpata DM; Department of Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio., Zuckerman ST; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio., Rosen MJ; Department of Surgery, Cleveland Clinic Comprehensive Hernia Center, Cleveland Clinic Foundation, Cleveland, Ohio., von Recum HA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio. Electronic address: horst.vonrecum@case.edu.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2017 Nov; Vol. 219, pp. 5-10. Date of Electronic Publication: 2017 May 08.
DOI: 10.1016/j.jss.2017.05.003
Abstrakt: Background: Given concern for hernia mesh infection, surgeons often use biologic mesh which may provide reduced risk of infection but at the cost of decreased repair durability. We evaluated mesh coating to provide sustained release of antibiotics to prevent prosthetic mesh infection and also allow a durable repair.
Materials and Methods: Cyclodextrin-based polymer was crosslinked onto multifilament polyester mesh and loaded with vancomycin (1.75 mg/cm 2 ). Pigs received modified meshes (n = 6) or normal, untreated meshes (n = 4), which were implanted into acute 10 × 5 cm ventral hernia, then directly inoculated with 10 6  colony-forming unit (CFU) of methicillin-resistant Staphylococcus aureus (MRSA). These were compared to animals receiving normal, uninfected mesh. All mesh was secured in an underlay bridge manner, and after 30 d, the abdominal wall was removed for quantitative bacterial culture and biomechanical analysis.
Results: All animals survived 30 d. All six animals with coated mesh cleared MRSA infection. The four control animals did not clear MRSA (P = 0.005). Quantitative bacterial load was higher in standard mesh versus drug-delivery mesh group (2.34 × 10 4 versus 80.9 CFU/gm). These data were log 10 -transformed and analyzed by Welch's t-test (P = 0.001). Minimum number of CFUs detectable by assay (300) was used instead of zero. Biomechanical analysis of controls (1.82 N/mm infected; 1.71 N/mm uninfected) showed no difference to the modified meshes (1.31 N/mm) in tissue integration (P = 0.15).
Conclusions: We successfully prevented synthetic mesh infection in a pig model using a cyclodextrin-based polymer to locally deliver vancomycin to the hernia repair site and clearing antibiotic-resistant bacteria. Polymer coating did not impact the strength of the hernia repair.
(Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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