Rifampicin-soaked Silver Polyester versus Expanded Polytetrafluoro-ethylene Grafts for In Situ Replacement of Infected Grafts in a Porcine Randomised Controlled Trial

Background: To compare the efficacy of in situ replacement with rifampicin-soaked silver-coated polyester (RSSCP) to that of expanded polytetrafluoroethylene (ePTFE) graft replacements in a porcine model for early aortic prosthetic vascular graft infection (PVGI). Material and methods: Sixty pigs received polyester or silver-coated grafts with an 8 mm diameter implanted end-to-end in the infrarenal aorta, and the grafts were inoculated with approximately 106 Staphylococcus aureus. All developed S. aureus PVGI. Two weeks later, the 52 surviving pigs were randomised to undergo in situ graft replacement with ePTFE or RSSCP grafts followed by oral administration of 300 mg rifampicin and 750 mg ciprofloxacin twice a day, postoperatively. After three weeks, all pigs were sacrificed. In situ perigraft swabs and graft material were analysed for S. aureus quantitatively. Results: Only one out of 25 RSSCP grafts were infected with S. aureus, whereas 15 of 27 ePTFE grafts were infected after 3 weeks (OR = 0.022, 95% CI: 0.002, 0.219, P = 0.001). Conclusions: In situ replacement with RSSCP grafts and oral rifampicin plus ciprofloxacin is more efficiency in eradicating S. aureus PVGI than ePTFE grafts treated with same oral antibiotics in a porcine aortic PVGI model. (C) 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.