Ing to Brockbank et. al., there are four eras in the history of homograft treatment for use in implantation in humans. In the first era, fresh aseptically recovered Dinaciclib site homografts were used, with implantation taking place within hours or days of recovery. In the second era, there was the extensive experimentation on variousdecontamination and storage techniques. Harsh methods of decontaminating homografts were explored, such as high concentration antibiotic incubation, gamma irradiation and chemical decontamination using formaldehyde, glutaraldehyde, beta- propriolactone and ethylene oxide. Although these techniques increased the availability of homografts, valve durability was adversely affected, resulting in poor clinical outcomes among patients. This caused a waning in interest in the use of such homografts for implantation. Gradual popularity of antibiotictreated refrigerated homografts marked the third era, where aseptically recovered homografts were treated with antibiotics and stored in various culture media at 4uC for up to 6 weeks. These milder techniques improved valve durability and ultimately, patient outcome. Finally, the current era uses a combination ofAntibiotic Decontamination of Homografts-Singaporetechniques, from aseptic homograft recovery to low-dose antibiotic decontamination, followed by cryopreservation and storage of the homografts in liquid nitrogen [1]. To prevent microbial transmission to the recipient, most cardiovascular homograft banks decontaminate the homografts with antibiotics. However, they vary in types, concentrations, incubation durations and temperatures, as currently, there is no consensus on an optimal formula [2,3]. Differences in practice could probably be attributed to the differences in local microflora as well as individual tissue banks’ experience and preferences. Despite the get DMXAA variations, reported rates of success in decontamination from different banks remain comparable at between 60 to 70 . This translates to a loss of approximately 30 of potential homografts due to decontamination failure. Hence, to meet the rising clinical demand for cardiovascular homografts, more effort is required to improve decontamination efficiency [2]. From 2008 to 2009, NCHB adopted the antibiotic regimen consisting of low concentration penicillin G and streptomycin (50 IU/mL and 50 ug/mL respectively). Homografts were incubated at 37uC for between 6 to 12 hours, in a nutrient medium, Medium 199 (M199), containing antibiotics. This regimen was effective until a homograft was tested positive for MRSA in a postrecovery tissue culture. Although post-antibiotic incubation cultured negative for microbiological growth, it prompted NCHB to review the effectiveness of its current antibiotic regimen against micro-organisms isolated from our homografts, as penicillin and streptomycin are ineffective against MRSA and other resistant strains of bacteria. Given the rising problem of antibiotic-resistant micro-organisms, Infectious Diseases physicians and pharmacist from the Singapore General Hospital (SGH) recommended the use of amikacin and vancomycin for decontamination against local microflora. The recommended concentrations for decontamination of homografts are at concentrations of 100 ug/mL for amikacin and 50 ug/ml for vancomycin [4]. Before implementing this new regimen, NCHB performed studies to determine the optimal incubation condition for both amikacin and vancomycin. In this report, we describe the results of these.Ing to Brockbank et. al., there are four eras in the history of homograft treatment for use in implantation in humans. In the first era, fresh aseptically recovered homografts were used, with implantation taking place within hours or days of recovery. In the second era, there was the extensive experimentation on variousdecontamination and storage techniques. Harsh methods of decontaminating homografts were explored, such as high concentration antibiotic incubation, gamma irradiation and chemical decontamination using formaldehyde, glutaraldehyde, beta- propriolactone and ethylene oxide. Although these techniques increased the availability of homografts, valve durability was adversely affected, resulting in poor clinical outcomes among patients. This caused a waning in interest in the use of such homografts for implantation. Gradual popularity of antibiotictreated refrigerated homografts marked the third era, where aseptically recovered homografts were treated with antibiotics and stored in various culture media at 4uC for up to 6 weeks. These milder techniques improved valve durability and ultimately, patient outcome. Finally, the current era uses a combination ofAntibiotic Decontamination of Homografts-Singaporetechniques, from aseptic homograft recovery to low-dose antibiotic decontamination, followed by cryopreservation and storage of the homografts in liquid nitrogen [1]. To prevent microbial transmission to the recipient, most cardiovascular homograft banks decontaminate the homografts with antibiotics. However, they vary in types, concentrations, incubation durations and temperatures, as currently, there is no consensus on an optimal formula [2,3]. Differences in practice could probably be attributed to the differences in local microflora as well as individual tissue banks’ experience and preferences. Despite the variations, reported rates of success in decontamination from different banks remain comparable at between 60 to 70 . This translates to a loss of approximately 30 of potential homografts due to decontamination failure. Hence, to meet the rising clinical demand for cardiovascular homografts, more effort is required to improve decontamination efficiency [2]. From 2008 to 2009, NCHB adopted the antibiotic regimen consisting of low concentration penicillin G and streptomycin (50 IU/mL and 50 ug/mL respectively). Homografts were incubated at 37uC for between 6 to 12 hours, in a nutrient medium, Medium 199 (M199), containing antibiotics. This regimen was effective until a homograft was tested positive for MRSA in a postrecovery tissue culture. Although post-antibiotic incubation cultured negative for microbiological growth, it prompted NCHB to review the effectiveness of its current antibiotic regimen against micro-organisms isolated from our homografts, as penicillin and streptomycin are ineffective against MRSA and other resistant strains of bacteria. Given the rising problem of antibiotic-resistant micro-organisms, Infectious Diseases physicians and pharmacist from the Singapore General Hospital (SGH) recommended the use of amikacin and vancomycin for decontamination against local microflora. The recommended concentrations for decontamination of homografts are at concentrations of 100 ug/mL for amikacin and 50 ug/ml for vancomycin [4]. Before implementing this new regimen, NCHB performed studies to determine the optimal incubation condition for both amikacin and vancomycin. In this report, we describe the results of these.
