Characteristics and prognosis in patients with prosthetic vascular graft infection: a prospective observational cohort study

Abstract

Prosthetic vascular graft infection (PVGI) is a devastating complication, with a mortality rate of up to 75%, which is especially caused by aortic graft infection. The purpose of this study was to evaluate factors associated with in-hospital mortality of patients with definite graft infection, and with long-term outcome. We reviewed medical records of 85 patients treated for PVGIs defined by positive bacterial culture of intraoperative specimens or blood samples, and/or clinical, biological and radiological signs of infection. In-hospital patient mortality was defined as any death occurring during the initial treatment of the graft infection. Cure was defined as the absence of evidence of relapsing infection during long-term follow-up (≥1 year). Eighty-five patients (54 aortic and 31 limb graft infections) treated by surgical debridement and removal of the infected prosthesis (n=41), surgical debridement without removal of prosthesis (n=34) or antimicrobial treatment without surgery (n=10) were studied. The only microbiological difference observed between patients with early (occurring within 4 months after surgery) vs. late PVGI and between those with aortic vs. limb PVGI was the incidence of PVGI caused by Staphylococcus aureus, which was greater in patients with limb PVGI. Overall cure was observed in 93.2% of 59 patients with a follow-up of a minimum of 1 year. Overall in-hospital mortality was 16.5% (n=14). Two variables were independently associated with mortality: age >70 years (OR 9.1, 95% CI 1.83-45.43, p 0.007) and aortic graft infection (OR 5.6, 95% CI 1.1-28.7, p 0.037).

Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC)

“…Although there is general consensus that AGI is diagnosed by a combination of clinical, radiological, and laboratory findings, where described in the methodology of a very small number of publications, diagnostic criteria lack precision and do not give sufficient "weight" to the most significant. 5,12,13 It is also important that any definition is useful in routine clinical practice, for example in situations where an infected device cannot be explanted and confirmatory microbiology is lacking. Here, criteria used to diagnose AGI are reviewed by an experienced, multidisciplinary group of clinicians and a formal case definition is derived by expert consensus.…”

Unexpected thoracic endograft infection following a colorectal procedure

“…Long-term imaging surveillance is also needed to ensure any disease progression is appropriately managed. More recently, prospective cohort studies found that in patients with infected stent-graft there was no difference in outcome with regard to vascular graft removal versus graft preservation [18,19]. In selected cases such as ours, prosthetic graft preservation may provide a definite treatment.…”

Infection of vascular grafts

“…Британское общество антими-кробной химиотерапии рекомендует комбиниро-ванную АБТ с цефуроксимом и метронидазолом [41], L. Legout et al (2012) при стафилококковой инфекции рекомендуют бета-лактамные или гли-копептидные антибиотики с аминогликозидами [42]. По данным M. Szczot et al (2011), комбини-рованная АБТ в сочетании с аминогликозидами у 37 пациентов резко снижает 30-дневную леталь-ность [43].…”

“…После удаления некротических, инфицированных тканей, транс-плантата внутривенная АБТ в течение 4-6 недель является оправданной. K. D. Calligaro et al (2003), L. Legout et al (2012) предлагают внутривенную АБТ в течение 6 недель с последующим перораль-ным приемом препаратов в течение 6-12 месяцев [4,42]. В Японии 9 пациентов выздоровели после внутривенной АБТ с последующим пероральным приемом препаратов в течение 3-6 месяцев [48].…”

“…В Японии 9 пациентов выздоровели после внутривенной АБТ с последующим пероральным приемом препаратов в течение 3-6 месяцев [48]. L. Legout et al (2012) при лечении 68 больных с инфицированием аутовенозных трансплантатов внутривенную АБТ проводили в течение 3 не-дель без перорального приема препаратов [42]. D. Mayer et al (2011) у 20 % пациентов с ПИ по-лучил хорошие отдаленные результаты после са-нации раны и трансплантата с активным (вакуум-ным) дренированием без АБТ [12].…”