A suspension of fibrin glue and antibiotic for local treatment of mycotic aneurysms in endocarditis--an experimental study.

The finding of mycotic aneurysms creates a major problem in surgery for both active bacterial endocarditis and prosthetic valve endocarditis. The value of local treatment of such aneurysms by a suspension of fibrin glue and an antibiotic was examined in an animal study since a previous in vitro investigation had indicated that such a suspension may discharge sufficient quantities of the antibiotic for up to 12 days. In 3 groups of 6 rabbits each, the entrance to the left atrial appendage was occluded subtotally. The endothelium within the cavity thus created was mechanically injured and the tip of a thin transthoracic catheter was placed in the cavity. In all animals, aliquots of staphylococcus aureus were injected through the catheter. All rabbits developed fever, and positive blood cultures were obtained in 16. The animals in group 1 were left without treatment. All 6 animals lost weight progressively, 4 animals died from sepsis, 2 rabbits were sacrificed after 6 days. Active endocarditis was demonstrated by histology and bacteriology in each animal. In group 2, 12.5 mg cephalotin were injected via the catheter 24 hours after the infection. Four animals died from sepsis, one rabbit had a positive tissue culture, and only one animal was free of infection on postoperative day 10. In group 3, 12.5 mg cephalotin suspended in fibrin glue was injected via the catheter 24 hours after the infection. All animals survived, became afebrile and resumed gain of weight. At autopsy after 10 days no infection was detectable. We conclude that a suitable antibiotic suspended in fibrin glue may allow for the sterilization of mycotic aneurysms in bacterial endocarditis.