Jornal Vascular Brasileiro
http://www.jvb.periodikos.com.br/article/doi/10.1590/1677-5449.200157
Jornal Vascular Brasileiro
Original Article

Infection of expanded polytetrafluoroethylene and Dacron-coated stents with Staphylococcus epidermidis: an experimental study in pigs

Infecção de stents revestidos com politetrafluoretileno expandido e Dacron com Staphylococcus epidermidis: estudo experimental em porcos

Clandio de Freitas Dutra; Adamastor Humberto Pereira; Claudia Wollheim; Rodrigo Pongiluppi; Roberto Fellini; Sérgio Ventura Gomes Junior; Henrique Nonemacher

Downloads: 0
Views: 748

Abstract

Abstract: Background: Diagnosis of the etiologic agent of endoprosthesis infections is essential to enable treatment, since these infections constitute important complications of endovascular procedures. Sonication of explanted tissue and materials is a technique that can be used to facilitate detection of biofilm-producing bacteria.

Objectives: To evaluate infection of pigs' aortas after implantation of nitinol stents coated with polytetrafluoroethylene (ePTFE) or Dacron, previously infected with biofilm-producing Staphylococcus epidermidis. Intimal thickening and the inflammatory response in the aortic wall were also evaluated.

Methods: 11 ePTFE-coated nitinol stents and 10 Dacron stents infected with S. epidermidis strains were implanted in the infrarenal aorta of 21 8-week-old pigs. After 2 weeks, the aorta containing the stents was removed. A vortex mixer and ultrasound were used to homogenize the samples and remove the biofilm. Subsequently, the number of colony-forming units was counted.

Results: There were no significant differences between the two groups in terms of the number of colony-forming units or of inflammation in the arterial wall. With the exception of one specimen from the Dacron group, all aortic stent cultures were positive for S. epidermidis.

Conclusions: There were no significant differences in the inflammatory response or infection rate between ePTFE and Dacron-coated stents actively infected with biofilm-producing S. epidermidis. Intimal thickening and the inflammatory response to infection of endoprostheses were similar. These results suggest that the two most widely used stent lining materials have a similar infection rate.

Keywords

stent, infection, Staphylococcus epidermidis, aorta, pigs

Resumo

Resumo: Contexto: O diagnóstico do agente etiológico é essencial para o tratamento das infecções de endoprótese, pois representam uma importante complicação do tratamento endovascular. A sonificação dos tecidos pode ser uma técnica usada para auxiliar na detecção de bactérias produtoras de biofilme.

Objetivos: Avaliar a infecção da aorta dos porcos após o implante de stents de nitinol revestidos com politetrafluoretileno (ePTFE) ou Dacron, infectados com Staphylococcus epidermidis, produtor de biofilme. O espessamento intimal e a resposta inflamatória na parede aórtica também foram avaliados.

Métodos: Onze stents de nitinol revestidos com ePTFE e 10 stents de Dacron infectados com cepas de S. epidermidis foram implantados na aorta infrarrenal de 21 porcos com 8 semanas de idade. Após duas semanas, a aorta contendo os stents foi removida. Um misturador de vórtice e ultrassom foram utilizados para homogeneizar as amostras e remover o biofilme. Posteriormente, o número de unidades formadoras de colônias foi contado.

Resultados: Não houve diferenças significativas no número de unidades formadoras de colônias ou inflamação na parede arterial entre os dois grupos. Todas as culturas de stent aórtico foram positivas para S. epidermidis, exceto uma no grupo Dacron.

Conclusões: Não houve diferenças significativas na resposta inflamatória ou na taxa de infecção entre os stents revestidos de ePTFE e Dacron, infectados ativamente pelo S. epidermidis produtor de biofilme. O espessamento intimal e a resposta inflamatória à infecção das endopróteses foram semelhantes. Esses resultados sugerem que os dois materiais de revestimento de stent mais amplamente utilizados têm uma taxa de infecção semelhante.
 

Palavras-chave

stent, infecção, Staphylococcus epidermidis, aorta, porcos

References

1 Coggia M, Goëau-Brissonniére O, Leflon V, Nicolas MH, Pechère J-C. Experimental treatment of vascular graft infection due to Staphylococcus epidermidis by in situ replacement with a rifampin-bonded polyester graft. Ann Vasc Surg. 2001;15(4):421-9. http://dx.doi.org/10.1007/s100160010128. PMid:11525531.

2 O’Gara JP, Humphreys H. Staphylococcus epidermidis biofilms: importance and implications. J Med Microbiol. 2001;50(7):582-7. http://dx.doi.org/10.1099/0022-1317-50-7-582. PMid:11444767.

3 Lejay A, Koncar I, Diener H, Vega De Ceniga M, Chakfé N. Postoperative infection of prosthetic grafts or stents involving the supra aortic trunks: a comprehensive review. Eur J Vasc Endovasc Surg. 2018;56(6):885-900. http://dx.doi.org/10.1016/j.ejvs.2018.07.016. PMid:30121172.

4 Chakfé N, Diener H, Lejay A, et al. European Society for Vascular Surgery (ESVS) 2020 Clinical practice guidelines on the management of vascular graft and endograft infections. Eur J Vasc Endovasc Surg. 2020;59(3):339-84. http://dx.doi.org/10.1016/j.ejvs.2019.10.016. PMid:32035742.

5 Gavali H, Mani K, Furebring M, Mogensen J, Wanhainen A. Branched endovascular aortic plug in patients with infrarenal aortic graft infection and hostile anatomy. J Endovasc Ther. 2020;27(2):328-33. http://dx.doi.org/10.1177/1526602819900988. PMid:31989857.

6 Chaufour X, Gaudric J, Goueffic Y, et al. A multicenter experience with infected abdominal aortic endograft explantation. J Vasc Surg. 2017;65(2):372-80. http://dx.doi.org/10.1016/j.jvs.2016.07.126. PMid:27720319.

7 Hogg ME, Peterson BG, Pearce WH, Morasch MD, Kibbe MR. Bare metal stent infections: case report and review of the literature. J Vasc Surg. 2007;46(4):813-20. http://dx.doi.org/10.1016/j.jvs.2007.05.043. PMid:17903662.

8 Popplewell MA, Garnham AW, Hobbs SD. A new technique to explant an infected aortic endograft. J Vasc Surg. 2015;62(2):512-4. http://dx.doi.org/10.1016/j.jvs.2015.03.033. PMid:25937607.

9 Sharif MA, Lee B, Lau LL, et al. Prosthetic stent graft infection after endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2007;46(3):442-8. http://dx.doi.org/10.1016/j.jvs.2007.05.027. PMid:17826231.

10 Bergamini TM, Bandyk DF, Govostis D, Vetsch R, Towne JB. Identification of Staphylococcus epidermidis vascular graft infection: a comparison of culture techniques. J Vasc Surg. 1989;9(5):665-70. http://dx.doi.org/10.1016/S0741-5214(89)70037-9. PMid:2524605.

11 Donlan RM. Biofilms and device-associated infections. Emerg Infect Dis. 2001;7(2):277-81. http://dx.doi.org/10.3201/eid0702.010226. PMid:11294723.

12 Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357(7):654-63. http://dx.doi.org/10.1056/NEJMoa061588. PMid:17699815.

13 Ulcar BK, Lakic N, Jeverica S, et al. Contribution of sonicate-fluid cultures and broad-range PCR to microbiological diagnosis in vascular graft infections. Infect Dis. 2018;50(6):429-35. http://dx.doi.org/10.1080/23744235.2017.1418529. PMid:29260928.

14 Waldvogel FA. Ultrasound: now also for microbiologists? N Engl J Med. 2007;357(7):705-6. http://dx.doi.org/10.1056/NEJMe078047. PMid:17699821.

15 Heilmann C, Schweitzer O, Gerke C, Vanittanakom N, Mack D, Götz F. Molecular basis of intercellular adhesion in the biofilm-forming Staphylococcus epidermidis. Mol Microbiol. 1996;20(5):1083-91. http://dx.doi.org/10.1111/j.1365-2958.1996.tb02548.x. PMid:8809760.

16 Cucarella C, Solano C, Valle J, Amorena B, Lasa I, Penadés JR. Bap, a Staphylococcus aureus surface protein involved in biofilm formation. J Bacteriol. 2001;183(9):2888-96. http://dx.doi.org/10.1128/JB.183.9.2888-2896.2001. PMid:11292810.

17 Dutra CF, Pereira AH. Digital morphometric analysis of the aortic wall in pigs following implantation of dacron-covered stents versus non-covered stents. Acta Cir Bras. 2004;19(3):210-9. http://dx.doi.org/10.1590/S0102-86502004000300006.

18 Argyriou C, Georgiadis GS, Lazarides MK, Georgakarakos E, Antoniou GA. Endograft infection after endovascular abdominal aortic aneurysm repair: a systematic review and meta-analysis. J Endovasc Ther. 2017;24(5):688. http://dx.doi.org/10.1177/1526602817722018. PMid:28756719.

19 Batt M, Feugier P, Camou F, et al. A meta-analysis of outcomes after in situ reconstructions for aortic graft infection. Angiology. 2018;69(5):370-9. http://dx.doi.org/10.1177/0003319717710114. PMid:28578619.

20 Lichtenfels E, Frankini AD, Cardozo MA, D’Azevedo PA. Infecção em endoprótese. J Vasc Bras. 2011;10(1):50-4. http://dx.doi.org/10.1590/S1677-54492011000100009.

21 Heafner TA, Lewis C, Baluh G, Clemens M, Propper B, Arthurs ZM. Initial inoculation concentration does not affect final bacterial colonization of in vitro vascular conduits. Surg Infect. 2018;19(3):352. http://dx.doi.org/10.1089/sur.2017.195. PMid:29466092.

22 Tavares SLS, Donzele JL, Oliveira RFM, Ferreira AS. Influence of environment temperature on the performance and the physiological traits of barrows from 30 to 60 kg. Rev Bras Zootec. 2000;29(1):199-205. http://dx.doi.org/10.1590/S1516-35982000000100027.

23 Paget DS, Bukhari RH, Zayyat EJ, Lohr JM, Roberts WH, Welling RE. Infectibility of endovascular stents following antibiotic prophylaxis or after arterial wall incorporation. Am J Surg. 1999;178(3):219-24. http://dx.doi.org/10.1016/S0002-9610(99)00114-2. PMid:10527443.

24 Thibodeaux LC, James CV, Lohr JM, Welling RE, Roberts WH. Infection of endovascular stents in a swine model. Am J Surg. 1996;172(2):151-4. http://dx.doi.org/10.1016/S0002-9610(96)00139-0. PMid:8795519.

25 Hearn AT, James KV, Lohr JM, Thibodeaux LC, Roberts WH, Welling RE. Endovascular stent infection with delayed bacterial challenge. Am J Surg. 1997;174(2):157-9. http://dx.doi.org/10.1016/S0002-9610(97)90075-1. PMid:9293834.

26 Johnson JJ, Jacocks MA, Gauthier SC, et al. Establishing a swine model to compare vascular prostheses in a contaminated field. J Surg Res. 2013;181(2):355-8. http://dx.doi.org/10.1016/j.jss.2012.06.056. PMid:22795350.
 


Submitted date:
10/27/2020

Accepted date:
12/15/2020

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
60d4c6b6a953957d3a5420d3 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections