Contamination occurs during ACL graft harvesting and manipulation, but it can be easily eradicated
Author(s):
Torres-Claramunt R. (Spanien)
,
Torres-Claramunt R. (Spanien)
Affiliations:
Pérez-Prieto D. (Spanien)
,
Pérez-Prieto D. (Spanien)
Affiliations:
Monllau J. C. (Spanien)
,
Monllau J. C. (Spanien)
Affiliations:
Pelfort López X. (Spanien)
,
Pelfort López X. (Spanien)
Affiliations:
Hinarejos P. (Spanien)
Hinarejos P. (Spanien)
Affiliations:
ESSKA Academy. Torres-Claramunt R. 05/09/18; 209389; P04-1558 Topic: Arthroscopic Surgery
Dr. Raúl Torres-Claramunt
Dr. Raúl Torres-Claramunt
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Abstract
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Objectives: Why anterior cruciate ligament (ACL) autograft soaking in a 5mg/ml vancomycin solution decreases the rate of infection has not been well-explained. One hypothesis is that grafts can be contaminated during harvesting and vancomycin eradicates the bacteria. The purpose of the present study is to assess how the vancomycin solution acts against ACL graft contamination during graft harvesting and preparation.

Methods: The study was carried out in 3 university hospitals over a period of 6 months. After sample size calculation, 50 patients were included in the study. Three samples were taken from each ACL graft. Sample 1 was obtained immediately after graft harvesting. After graft manipulation and preparation, the remaining tissue was divided into two parts. The raw sample was denominated sample 2 and sample 3 consisted of the rest of the remaining tissue that had been soaked in the vancomycin solution. All the cultures were incubated at 37ºC with 5% CO2 in agar plates for 7 days (aerobically) or 14 days (anaerobically) and inspected daily for microbial growth. Any bacterial growth and the number of colony forming units were reported.

Results: In 7 cases (14%), either sample 1 or sample 2 were positive. In 5 of the cases (10%), only the sample after graft preparation was positive (sample 2). In 2 cases (4%), sample 1 and sample 2 were positive for the same bacteria. Isolated microorganisms corresponded to coagulase-negative staphylococci (CNS) and Propionibacterium acnes. No bacterial growth was observed in sample 3 (p<0.001). Thus, none of those 7 positive cases (0%) were positive after vancomycin soaking (p<0.001).

Conclusions: In the series, ACL graft harvesting and manipulation leads to bacterial contamination in 14% of the cases. This contamination is fully eradicated after soaking in the vancomycin solution in this series.

Keywords:
ACL infection, harvest contamination, vancomycin soaking
Objectives: Why anterior cruciate ligament (ACL) autograft soaking in a 5mg/ml vancomycin solution decreases the rate of infection has not been well-explained. One hypothesis is that grafts can be contaminated during harvesting and vancomycin eradicates the bacteria. The purpose of the present study is to assess how the vancomycin solution acts against ACL graft contamination during graft harvesting and preparation.

Methods: The study was carried out in 3 university hospitals over a period of 6 months. After sample size calculation, 50 patients were included in the study. Three samples were taken from each ACL graft. Sample 1 was obtained immediately after graft harvesting. After graft manipulation and preparation, the remaining tissue was divided into two parts. The raw sample was denominated sample 2 and sample 3 consisted of the rest of the remaining tissue that had been soaked in the vancomycin solution. All the cultures were incubated at 37ºC with 5% CO2 in agar plates for 7 days (aerobically) or 14 days (anaerobically) and inspected daily for microbial growth. Any bacterial growth and the number of colony forming units were reported.

Results: In 7 cases (14%), either sample 1 or sample 2 were positive. In 5 of the cases (10%), only the sample after graft preparation was positive (sample 2). In 2 cases (4%), sample 1 and sample 2 were positive for the same bacteria. Isolated microorganisms corresponded to coagulase-negative staphylococci (CNS) and Propionibacterium acnes. No bacterial growth was observed in sample 3 (p<0.001). Thus, none of those 7 positive cases (0%) were positive after vancomycin soaking (p<0.001).

Conclusions: In the series, ACL graft harvesting and manipulation leads to bacterial contamination in 14% of the cases. This contamination is fully eradicated after soaking in the vancomycin solution in this series.

Keywords:
ACL infection, harvest contamination, vancomycin soaking
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