Prosthetic vascular graft infections: bacterial cultures from negative pressure wound therapy foams do not improve diagnostics (original) (raw)
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Prosthetic Vascular Graft Infection: A Multi-Center Review of Surgical Management
The Yale Journal of Biology and Medicine, 2007
A multi-center retrospective review of major prosthetic graft infection outcomes was undertaken to determine graft preservation and limb salvage rates. The management of infected prosthetic vascular grafts continues to be controversial. The purpose of this study was to review the surgical management of major extracavitary prosthetic vascular graft infections and to correlate the outcomes on the basis of bacteriology and grade. The change in patient population seen by vascular surgeons and the recent emergence of more virulent bacterial strains should influence surgical management. Bacteriology and severity of infection based on grade must play a greater role in the selection criteria for graft salvage. Despite advancement in the understanding of these interactions and the emergence of new management algorithms, we are continuing to operate without a uniform standard in managing this difficult and rapidly evolving clinical problem.
Prosthetic Vascular Graft Infections: A Contemporary Approach to Diagnosis and Management
Current Infectious Disease Reports, 2011
Improvements in manufacturing and implantation techniques, coupled with an increasing prevalence of atherosclerosis in an aging population, have led to increased utilization of prosthetic vascular grafts. The infection rates of vascular grafts are low. However, when they do occur, high rates of morbidity and mortality can be expected. The purpose of this article is to review the published literature regarding
Mechanism of late prosthetic vascular graft infection
Cardiovascular Surgery, 1997
This study was a retrospective analysis of 41 patients with late prosthetic graft infections (> 30 days after operation) from six hospitals in the southwest of England. The 41 patients had a median age of 66 years and generally accepted risk factors for infection were documented in 19 patients preoperatively. Thirteen patients had postoperative wound complications and three had early reoperation at the site of subsequent infection. The median time between index operation and symptoms of infection was 10 (range 1-224) months. Abscess (46%) was the most common presentation followed by false aneurysm (20%) and graft thrombosis (20%). All patients had reoperations (median two per patient, range one to seven). Seven (17%) patients died and 10 (24%) required a major amputation. Bacteria were isolated from retrieved grafts in 23/41 patients (high virulence 14, low virulence nine) and the most frequent organism was coagulase-negative Staphylococcus epidermidis (nine patients). In the majority of cases the aetiology of the late infections in this series was consistent with bacterial implantation at the index operation, but in four cases bacteraemia or intraperitoneal spread was more likely. Dental-type antibiotic prophylaxis would not have prevented any of the infections in this study. Aggressive treatment of recognized sources of infection in patients with vascular grafts is imperative.
Infection of Vascular Prostheses: A Comprehensive Review
Prosthesis
Vascular graft or endograft infection (VGEI) is a complex disease that complicates vascular-surgery and endovascular-surgery procedures and determines high morbidity and mortality. This review article provides the most updated general evidence on the pathogenesis, prevention, diagnosis, and treatment of VGEI. Several microorganisms are involved in VGEI development, but the most frequent one, responsible for over 75% of infections, is Staphylococcus aureus. Specific clinical, surgical, radiologic, and laboratory criteria are pivotal for the diagnosis of VGEI. Surgery and antimicrobial therapy are cornerstones in treatment for most patients with VGEI. For patients unfit for surgery, alternative treatment is available to improve the clinical course of VGEI.
Vascular prosthetic graft infection: epidemiology, bacteriology, pathogenesis and treatment
Acta chirurgica Belgica, 2002
Vascular prosthetic graft infection remains a major surgical challenge. Prevention of risk factors and antibiotic therapy can reduced but not eradicate it. Management of infected vascular grafts depends on several factors, including the location of the infected prosthesis, the extent of infection, and the underlying micro-organism. Classic treatment consists of extra-anatomic bypass grafting. The disappointing results due to the high mortality and amputation rate have kindled interest in alternative approaches, such as in situ reconstruction with antibiotic-bonded prostheses, autogenous veins or arterial allografts. We focused on the treatment of aortic graft infection by means of both fresh and cryopreserved arterial allograft. Here, the experience of the Italian Collaborative Vascular Homograft Group is reported. Between March 1994 and December 2000 seventy-nine patients with aortic graft infection were treated. The results of 68 patients are analysed. Eleven patients were treated...
Swiss Medical Weekly, 2013
Vascular procedures are rarely complicated by infection, but if prosthetic vascular graft infection (PVGI) occurs, morbidity and mortality are high. Several patient-related, surgery-related and postoperative risk factors are reported, but they are not well validated. PVGI is due to bacterial colonisation of the wound and the underlying prosthetic graft, generally as a result of direct contamination during the operative procedure, mainly from the patient's skin or adjacent bowel. There is no consensus on diagnostic criteria or on the best management of PVGI. On the basis of reported clinical studies and our own experience, we advocate a surgical approach combining repeated radical local debridement, with graft preservation whenever possible or partial excision of the infected graft, depending on its condition, plus simultaneous negative-pressure wound therapy (NPWT). In addition, antimicrobial therapy is recommended, but there is no consensus on which classes of agent are adequate for the treatment of PVGI and whether certain infections may be treated by means of NPWT alone. Since staphylococci and Gram-negative rods are likely to be isolated, empirical treatment might include a penicillinase-resistant beta-lactam or a glycopeptide, plus an aminoglycoside, the latter for Gram-negative coverage and synergistic treatment of Gram-positive cocci. Additionally, empirical treatment might include rifampicin since it penetrates well into biofilms.
Prosthetic vascular graft infection: A risk factor analysis using a case–control study
Journal of Infection, 2006
Objectives: Several factors have been anecdotally reported to increase the risk of prosthetic vascular graft infection (PVGI), a serious complication with high mortality and limb amputation rates. The goal of this study is to confirm purported risk factors using a well-designed statistical model. Methods: Patients undergoing vascular graft placement at Mayo Clinic Rochester between January 1, 1982 and December 31, 2002 were retrospectively evaluated, excluding redo cases. PVGI cases had to meet one of the following criteria: perigraft air or fluid O8 weeks postoperatively, positive Gram stain or cultures of graft or perigraft material, intraoperative gross purulence, failure of graft incorporation, or exposed graft. Each case had two controls matched for age, gender and date of surgery. Duration of follow-up for a given control had to be at least equal to the time to infection of the corresponding case. Demographic and other clinical data were collected for each patient. Results: Fifty-one cases and 102 controls met the inclusion criteria. Median age was 68 years. Staphylococcal species were identified in 45% of the total number of cases, and 60% of cases with a recovered organism. Univariate analysis identified groin incision, wound complication and wound infection as significant risk factors for PVGI (p!0.005 for all three factors). After adjusting for age and surgery date, multivariate analysis confirmed the statistical significance of groin incision and wound infection as risk factors for PVGI. Conclusions: This is the first published risk factor analysis that includes statistical evaluation in a case-control study of PVGI. Groin incision, wound complication, and wound infection are significantly associated with developing PVGI. These findings will assist in identifying patients at increased risk of developing subsequent infection.
European Journal of Vascular and Endovascular Surgery, 2002
Methods: gelatin-sealed Dacron grafts were interposed in the infrarenal aorta of 36 mongrels and inoculated with 1 ml of a S. aureus suspension. Group 1 (control group) received no prophylaxis and were inoculated with 1 ml containing 10 9 cfu/ml. Group 2 (n=6) received systemic prophylaxis (1 g cephamandole) and were inoculated with 10 5 cfu/ml (n= 3) or 10 7 cfu/ml (n=3). Group 3 received systemic prophylaxis (1 g cephamandole) and were inoculated with 10 9 cfu/ml. Group 4 received systemic prophylaxis (2 g cephamandole) and were inoculated with 10 9 cfu/ml. In group 5 and 6 grafts were soaked in a rifampicin solution before use and inoculated with 10 9 cfu/ml. Group 5 received no systemic prophylaxis and group 6 received systemic prophylaxis (1 g cephamandole). Grafts were harvested at 2 weeks, and peritonitis, perigraft abscess, anastomotic disruption and graft occlusion recorded. Swabs were taken of the graft, the perigraft tissues and the peritoneal fluid. Graft segments were incubated in broth medium. Results: inoculation with 10 9 cfu/ml ensured graft infection. Sytemic or local prophylaxis alone failed to prevent graft infection. Only systemic and local antibiotic prophylaxis provided significant better results than no prophylaxis at all (p<0.01) and local prophylaxis alone (p<0.05). However, total "graft sterility" was not achieved as bacteriologic analysis of the graft segments showed low bacterial counts (<10 bacteria/graft) in 5 of 6 grafts. Conclusion: local and systemic prophylaxis provided more protection as demonstrated by the significant decrease in the incidence of "overt" graft infection. Total "graft sterility" cannot be expected in the case of an overwhelming bacterial challenge.
Infection of Vascular Prostheses
ANZ Journal of Surgery, 1991
Graft infection occurred in I 1 of 322 patients (3.4%) who had insertion of a vascular prosthesis for peripheral vascular disease during a 4-year period. The groin was the most common site of infection and multiple resistant Sraphylococcus aureus (MRSA) was the most common organism responsible. Six of 7 MRSA infections occurred following a procedure involving a previously placed graft andlor a groin incision. Prophylactic antibiotics effective against MRSA are recommended for patients having a revisional procedure, especially involving the groin.