Infectibility of endovascular stents following antibiotic prophylaxis or after arterial wall incorporation

• Published in: The American journal of surgery 1999-09, Vol.178 (3), p.219-224
• Main Authors: Paget, Douglas S, Bukhari, Rizwan H, Zayyat, Elie J, Lohr, Joann M, Roberts, William H, Welling, Richard E
• Format: Article
• Language: English
• Subjects: Angioplasty; Animals; Antibiotic Prophylaxis; Antibiotics; Arteries; Bacteremia; Bacteremia - etiology; Bacteremia - prevention & control; Bacteria; Balloon treatment; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Blood vessels; Cardiovascular system; Case reports; Catheters; Cefazolin; Cefazolin - therapeutic use; Cephalosporins - therapeutic use; Coronary vessels; Disease prevention; Euthanasia; Female; Hogs; Iliac Artery - microbiology; Iliac Artery - surgery; Implants; Infections; Inflammation; Intravenous administration; Medical sciences; Placement; Prophylaxis; Prostheses; Software; Staphylococcal Infections - etiology; Staphylococcal Infections - prevention & control; Staphylococcus aureus; Stents; Stents - adverse effects; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Swine; Thromboembolism; Thrombosis; Time Factors; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Veins & arteries
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(99)00114-2

Background: Case reports of endovascular stent infection have been accumulating in the last several years. We sought to determine if prophylactic antibiotics would prevent stent/artery complex infections in a swine model if given before a bacterial challenge at the time of stent placement and 4 weeks following deployment. We also investigated whether arterial wall incorporation protected the stent against infection without antibiotic prophylaxis. Methods: Balloon expandable Palmaz stents were placed in the iliac arteries of 42 swine. At the same time, angioplasty was performed on the contralateral iliac artery as a control. In group A, prophylactic cefazolin was given to 12 swine at the time of stent deployment followed by an intraaortic bacterial challenge of Staphylococcus aureus. In group B, 10 swine received prophylactic cefazolin followed by intravenous S aureus 4 weeks after iliac stenting and angioplasty. In group C, 3 months following iliac stent placement and angioplasty an intravenous bacterial challenge was administered with S aureus. All swine were euthanized, and the iliac stent/artery complex and the contralateral angioplastied iliac artery were harvested and sent for culture and pathology. Experimental groups were compared with results from our previously published swine infection model using the Fisher’s exact test. P values were considered significant if less than 0.05. Results: Group A: Two of the 12 (17%) stent/artery complexes in the antibiotic treatment group had positive cultures. This compares with 7 of 10 (70%) in the control group ( P = 0.016). In addition, there was one infection in an angioplastied vessel contralateral to one of the two stent infections. Molecular strain typing verified that the positive cultures were the same strain that was used to challenge the animals. No vessel thrombosis occurred in the stented arteries even in the presence of infection. Group B: One of 10 (10%) stented iliac arteries had a culture positive infection. This compares with 7 of 14 (50%) positive cultures in the control group ( P = 0.04). In addition, one angioplastied vessel did have mild S aureus growth on culture. Both positive cultures were verified to be the same as the injected strain by molecular strain typing. There were no thrombosed or occluded vessels. Group C: One of 15 patent stents had growth of S aureus on culture and evidence of acute inflammation on histopathologic examination. The stent infection rate of 1 of 15 (7%) patent st