Efficacy of antiseptic impregnation of aortic endografts with rifampicin compared to silver against in vitro contamination with four bacteria that frequently cause vascular graft infections

• Main Authors: Susanne Honig, MD, Philipp Seeger, Holger Rohde, MD, Tilo Kölbel, MD, Eike Sebastian Debus, MD, Holger Diener, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-01-01
• Series: JVS - Vascular Science
• Subjects: Vascular graft infection; Endograft infection; Impregnation; Silver; Rifampicin
• Online Access: http://www.sciencedirect.com/science/article/pii/S2666350320300110

Objective: This in vitro study investigates the antimicrobial efficacy of impregnation of commercially available aortic endografts (EG) with rifampicin (RIF) and nanocolloidal silver. Methods: Endografts were flushed with 50 mL of RIF 600 mg, 70 mL of a silver-based aqueous solution (AG), or 50 mL of phosphate-buffered saline (PBS) over 15 minutes. Endografts were then retrieved from the sheath and cut in 1 × 1 cm sized graft units (n = 80 of each impregnation), which were then incubated for 1 hour separately with inoculates containing 106 or 103 bacteria per milliliter (bact/mL) of each of the following bacteria: Staphylococcus epidermidis, Escherichia coli, multisensitive Staphylococcus aureus, and Pseudomonas aeruginosa. After sonication of the graft units, bacterial counts were measured by plating out twice the sonication solution on Mueller-Hinton plates. Results: RIF showed a statistically significant decrease of colony forming units per milliliter for all four bacterial strains in both concentrations compared with PBS and AG, except for 103 bact/mL of E coli. AG showed a significant decrease of colony forming units per milliliter compared with PBS only for 106 bact/mL of E coli and was statistically significantly inferior to RIF for all four bacterial strains in both concentrations with the exception of E coli at a concentration of 103 bact/mL. Conclusions: This in vitro study demonstrated infectivity resistance of aortic EG after flushing with RIF. Moreover, the feasibility of flushing aortic EG with a new silver-based agent could be demonstrated, but without statistically significant antimicrobial efficacy compared with native EG. : Clinical Relevance: Because the number of elective and emergency endovascular procedures on the thoracic and abdominal aorta is continuously increasing, endograft infections in both locations are also more frequently observed. The necessity and use of antimicrobial-impregnated EG in the prophylaxis or treatment of endograft infections has so far neither been discussed in the literature nor addressed in existing guidelines. This is the first study investigating the influence of antiseptic impregnations of commercially available aortic EG on in vitro contamination with bacteria commonly causing vascular graft infections. Owing to proven infectivity resistance, flushing EG with RIF could, despite known limitations, lead to a modification of established therapeutic principles in patients at high risk for aortic graft infections.