Sustained-release vancomycin sheet may help to prevent prosthetic graft methicillin- resistant Staphylococcus aureus infection Keiichi Hirose, MD, PhD,

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Sustained-release vancomycin sheet may help to prevent prosthetic graft methicillin- resistant Staphylococcus aureus infection Keiichi Hirose, MD, PhD, Akira Marui, MD, PhD, Yoshio Arai, MD, Takamasa Nomura, PhD, Sachiko Inoue, M.Eng, Kozo Kaneda, MD, Tetsuya Kamitani, MD, Masatoshi Fujita, MD, PhD, Masao Mitsuyama, MD, PhD, Yasuhiko Tabata, PhD, DMSc, Dpharm, Masashi Komeda, MD, PhD Journal of Vascular Surgery Volume 44, Issue 2, Pages 377-382 (August 2006) DOI: 10.1016/j.jvs.2006.03.043 Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 1 Profile of vancomycin (VCM) release from a VCM-poly-L-lactide-co-caprolactone (PLCA) sheet. The x-axis shows the time course and the y-axis shows the percentage of VCM remaining in the harvested sheet. Journal of Vascular Surgery 2006 44, 377-382DOI: (10.1016/j.jvs.2006.03.043) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 2 Tissue concentration of vancomycin (VCM) around the Dacron sheet. The x-axis shows the time course and the y-axis shows the concentration of VCM (μg/mL). VCM-poly-L-lactide-co-caprolactone (PLCA) group (closed circle, solid line): implantation of a sterile Dacron sheet and a VCM-PLCA sheet; VCM-solution group (open circle, dotted line): implantation of a sterile Dacron sheet and a local bolus injection of an aqueous solution of VCM. Journal of Vascular Surgery 2006 44, 377-382DOI: (10.1016/j.jvs.2006.03.043) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions

Fig 3 Micrographs of the tissue around the Dacron sheet on day 7 after the operation for animal experiment 3. A, Only slight inflammation was seen (arrow, Dacron sheet) (hematoxylin and eosin [HE] stain, ×100). B, Severe inflammation such as edematous and congestive change and permeation of inflammatory cells around the Dacron sheet including skin dehiscence was observed (black arrow, skin dehiscence; yellow arrow, bacterial cells of as methicillin-resistant Staphylococcus aureus [MRSA]) (HE stain, ×100). C, Only slight inflammation was seen as well as 3A (arrow, remaining VCM-PLCA sheet) (HE stain, ×100). D, Bacterial cells of MRSA (arrow) were found in the Dacron fiber (Gram stain, ×400). E, No bacterial cells of MRSA were found in the Dacron fiber. Group A, a Dacron sheet and MRSA inoculation; group D, a Dacron sheet with a vancomycin -poly-L-lactide-co-caprolactone (VCM-PLCA) sheet and MRSA inoculation; group E, a Dacron sheet with a VCM-PLCA sheet (without MRSA) (Gram stain, ×400). Journal of Vascular Surgery 2006 44, 377-382DOI: (10.1016/j.jvs.2006.03.043) Copyright © 2006 The Society for Vascular Surgery Terms and Conditions