1337. Synergistic, Meltable Antimicrobial Wrap for Reducing Tissue Expander Infections in patient with breast reconstruction
Session: Poster Abstract Session: Clinical Trials
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background: Infection rates for silicone tissue expanders (TE) used in breast reconstruction is reported to range between 2.5-24%.  Studies have shown that irrigation of an antimicrobial solution within the surgical pocket may reduce the incidence of TE infections as well as capsular contracture.  Unfortunately, data at our institution revealed that within 30 days of surgery, despite receiving proper antimicrobials within the surgical pocket, this preventive measure was associated with a breakthrough infection in 32% of the cases.  To improve outcomes, and half-life of these antimicrobials, we developed a novel method of applying a viscous antimicrobial coating, where the coating is applied as a solid film around the expander for implantation, which latter melts in situ to form a conformal viscous coating.

Methods: One cm disks of expander silicone shell material were covered with a gelatin-based film containing 0.1 mg/ml minocycline (M), 0.05 mg/ml rifampin (R) and 50 mg/ml sodium mercaptoethane sulfonate (MeSNA), which has demonstrated reduction in capsule thickness.   Films with M/R alone, MeSNA alone and no antmicrobial agent were prepared as controls.  The disks were then incubated with 5.5x105 cfu/ml inocula of clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant Pseudomonas aeruginosa (Ps aerug).  After a 24-hour incubation period, quantification of the adherent organisms was performed by sonicating the disks followed by serial dilution and plating of the sonication fluid. 

Results:   Quantitative recoveries from the infected silicone shell disks are presented in the plot below:

Conclusion:   The gelatin-based film melted within 10 minutes at 37C.  The film by itself had no impact on microbial attachment.  The combination of MeSNA and low dose M/R reduced adherence of MRSA and Ps aerug by a factor of 10 over M/R alone.

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Joel Rosenblatt, PhD1, Ray Hachem, MD2, Ruth Reitzel, MS2, George M. Viola, MD, MPH3 and Issam Raad, MD2, (1)UT MD Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (3)Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

J. Rosenblatt, None

R. Hachem, None

R. Reitzel, None

G. M. Viola, None

I. Raad, American Medical Systems: , Licensing agreement or royalty
Cook: Speaker's Bureau, Grant recipient and Licensing agreement or royalty
ECP: ,
Great Lakes Pharmaceuticals: ,
Inventive Protocol, Inc.: ,
Medline: , Licensing agreement or royalty
TyRx: , Licensing agreement or royalty

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