In Vitro Antimicrobial Activity of Fibrin Sealants Containing Antimicrobial Agents

Background: Antimicrobial prophylaxis is required to prevent surgical site infections (SSIs). However, it is difficult to maintain prolonged antimicrobial activity in the surgical incision. Fibrin sealants are used primarily for hemostasis, suture support, or the adhesion of tissues. The aim of this study was to develop fibrin sealants that exhibit antimicrobial activity due to the addition of an antimicrobial agent. Methods: We determined the potencies and activities of cefazolin, ampicillin-sulbactam, vancomycin, teicoplanin, and arbekacin eluted from fibrin sealants. The antimicrobial activity was evaluated using methicillin-resistant Staphylococcus aureus (MRSA), multi-drug-resistant Pseudomonas aeruginosa (MDRP), and multi-drug-resistant Acinetobacter baumannii (MDRAB), which are the major pathogens responsible for hospital-acquired infections. Results: Each antimicrobial agent eluted continuously from the fibrin clots for approximately two weeks. All eluates from fibrin clots containing antimicrobial agents maintained antimicrobial activity against MRSA for at least 7d. The eluates from fibrin clots containing ampicillin-sulbactam inhibited the growth of both MDRP and MDRAB for at least 5d. Conclusion: Our data suggest that the addition of an antimicrobial agent to fibrin sealants is a useful method to prevent SSIs caused by bacteria, including antimicrobial-resistant strains.