Gentamicin beads in vascular surgery: long-term results of implantation

The authors conducted a prospective study, with a subsequent review of case -notes and followup of patients, to review the results of insertion of gent amicin beads for the prevention and treatment of infection in vascular surg ery. In particular, special reference was given to leaving chains of beads permanently implanted in the body. There were thirty-five patients in whom gentamicin beads were used in 62 sites. These were implanted completely in 45, left protruding for removal in 15: and in open wounds in two. Forty-two chains of beads were left permanently implanted, and these patients were f ollowed up for 1-44 months (median 15) later, There was no further infectio n at 60% of the sites where gentamicin beads were used to treat proven graf t sepsis, and 50% of sites in various sinuses. Infection developed at 16% o f the sites where gentamicin beads were used prophylactically. Adverse effe cts were observed in three cases of long-term implantation: one chain of be ads caused discomfort that required removal, the skin failed to heal over o ne chain, and one may possibly have caused a bypass graft to kink and occlu de. In conclusion, gentamicin beads are a useful adjunct in the management of vascular graft infection and in prophylaxis for some high risk cases. Ch ains of beads can be implanted long term with few adverse sequelae. (C) 199 9 The International Society for Cardiovascular Surgery. Published by Elsevi er Science Ltd, All rights reserved.