Systemic and local antibiotic prophylaxis in the prevention of Staphylococcus epidermidis graft infection

BACKGROUND: The aim of the study was to investigate the in vivo efficacy of local and systemic antibiotic prophylaxis in the prevention of Staphylococcus (S.) epidermidis graft infection in a rat model and to evaluate the bacterial adherence to frequently used prosthetic graft materials. METHODS: Graft infections were established in the subcutaneous tissue of 120 male Wistar rats by implantation of Dacron/ePTFE grafts followed by topical inoculation with 2 × 10(7 )CFUs of clinical isolate of methicillin-resistant S. epidermidis. Each of the graft series included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received systemic prophylaxis with teicoplanin or levofloxacin and two contaminated groups that received teicoplanin-soaked or levofloxacin-soaked grafts. The grafts were removed 7 days after implantation and evaluated by quantitative culture. RESULTS: There was significant bacterial growth inhibition in the groups given systemic or local prophylaxis (P < 0.05). Methicillin-resistant S. epidermidis had greater affinity to Dacron graft when compared with ePTFE graft in the untreated contaminated groups (P < 0.05). CONCLUSION: The study demonstrated that the usage of systemic or local prophylaxis and preference of ePTFE graft can be useful in reducing the risk of vascular graft infections caused by staphylococcal strains with high levels of resistance

Glucan-Based Macrophage Stimulators

Sepsis and sepsis syndrome are significant causes of morbidity and mortality in critically ill surgical patients. Despite technological and therapeutic advances in critical care, sepsis continues to be a pivotal factor in 20 to 50% of deaths in surgical intensive care units. It is clear that alternative approaches to the prevention and/or treatment of sepsis must be found. Preclinical data indicate that macrophage activation with ( I -\u3e3)-D-gIucans will ameliorate sequelae associated with Gram-negative septicaemia. We and others have translated these preclinical observations to the clinical setting and have shown that macrophage activation with (l-\u3e3)-D-gIucans will significantly reduce septic morbidity and mortality in trauma and/or high-risk surgical patients. The precise mechanism(s) by which ( I-\u3e3)-D-glucans prevent or ameliorate infections have not been fully elucidated. However, recent data suggest the anti-infective efficacy of (l-\u3e3)-D-gIucans is attributable, in part, to macrophage activation induced by binding of (l-\u3e3)-D-gIucan to a specific receptor followed by modulation of macrophage pro-inflammatory cytokine expression. This article reviews the anti-infective potential of ( l-3)-D-glucans in the prevention of sepsis and septic sequelae

The ortho-plastic approach to soft tissue management in trauma.

Fractures with associated soft tissue injuries, or those termed 'open,' are not uncommon. There has been much discussion regarding there management, with the guidance from the combined British Orthopaedic Association and British Association and Aesthetic Surgeons teams widely accepted as the gold level of therapy. We aim to discuss the current evidence about the initial management of this group of injuries, taking a journey from arrival in the accident and emergency department through to the point of definitive closure. Other modes of therapy are also reviewed