Infected Prosthetic Dialysis Arteriovenous Grafts: A Single Dialysis Center Study

Abstract

Background: The prosthetic arteriovenous grafts (AVG) being used increasingly to create hemodialysis access are prone to infections that pose potentially life-threatening infectious and bleeding complications, as well as loss of dialysis access. In this study, we identified the bacteriologic agents of infected AVGs by site swab, blood culture, and prosthesis cultures, and to evaluate the role of microbiological findings in the management of the infection. Methods: We focused on 51 patients with 53 AVGs operated on in our clinic from January 2006 to December 2009. An infected AVG was identified by clinical, ultrasound, and microbiological findings. Sensitivity to antibiotics was determined for all bacterial strains. Isolates were identified by pulsed-field gel electrophoresis (PFGE) of bacterial DNA. In a few cases, positron emission tomography-computed tomography (PET-CT) examination was performed. Results: Strains of Staphylococcus spp., especially S. aureus, were the most frequent cause of infected AVG. All S. aureus strains were sensitive to methicillin. With the exception of a single case, isolates obtained simultaneously from the skin site and the vascular prosthesis were identical genetically. Conclusions: Our results suggest that bacterial infectious agents detected in site swab, blood, or graft culture confirm a suspicion of AVG infection. A PET-CT examination can provide confirmation. The combination of microbiologic and radionuclide findings can improve the management of the AVG infection, but surgery remains essential.

Susceptibility of ePTFE vascular grafts and bioengineered human acellular vessels to infection

“…Although this technology has been useful for many years, one of its frequent failure modes in the clinic is that of bacterial colonization and infection. [1][2][3] Following implantation and hemodialysis access, it has been reported that as many as 28% of synthetic vascular grafts, 4 such as those constructed from expanded polytetrafluorethylene (ePTFE), will require revision or explant due to infection, which significantly impacts medical costs and patient morbidity. 5,6 It has been suggested that the microporous structure and synthetic composition of ePTFE grafts provide niches for bacterial accumulation 7 and interferes with the ability of host leukocytes to combat bacterial infections.…”

“…Consequently, bacterial infection is the second leading cause of death in hemodialysis patients with end-stage renal disease. 10 Gram-positive Staphylococcus aureus is responsible for the majority of vascular access infections 4,11 and subsequently linked to higher rates of patient mortality from serious medical complications including infective endocarditis and osteomyelitis. 12 Staphylococci have been shown to strongly adhere to the surface of implanted materials and then form a biofilm that often enables the bacterial infection to persist, despite prolonged antibiotic therapy.…”

“…16 Moreover, HAVs implanted in these patients have had a low infection rate (1.3% per patient-year), comparable to that of native arteriovenous fistulas used for chronic hemodialysis. 1,4 In this study, we directly compare the susceptibility of HAV and ePTFE graft material to infection, using a well-controlled and established animal model of subdermal implantation with bacterial contamination. [17][18][19] Although repetitive postoperative needle punctures of the material would be more representative of dialysis cannulation events and potential infection, we chose to evaluate the response to one wellcontrolled intraoperative bacterial contamination event to determine each material's resistance to infection, as well as to limit animal distress and experimental variability.…”

Creation of arteriovenous fistula for hemodialysis in the older population

“…Our study did not confirm a correlation with diabetes. Infection complications related to the AVG are well known; however, its correlation with age was not confirmed 15 .…”

Sustained release of vancomycin from novel biodegradable nanofiber-loaded vascular prosthetic grafts: in vitro and in vivo study

“…3,4 It has been found to account for about 35% of patients losing AV grafts. 5 S. aureus is the leading cause of AV graft infection, 6 and MRSA has emerged as the most prevalent pathogen. 7 Evidence suggests that mortality associated with MRSA infection is much higher than mortality from methicillin-susceptible S. aureus infection.…”