Reinfection after resection and revascularization of infected infrarenal abdominal aortic grafts

Abstract

Revascularization after excision of infected abdominal aortic grafts can be done with acceptable in-hospital morbidity and mortality. Reinfection is problematic, regardless of revascularization conduit, and is associated with limb loss and death. New and aggressive local anti-infective strategies are warranted.

In vitro efficacy of antibiotic beads in treating abdominal vascular graft infections

“…Regardless of the surgical technique used, reinfection affects up to 20% of patients treated for graft infection. 9 We postulate that antibiotic beads are adjunctive and should not replace standard treatment of infected abdominal vascular grafts. Antibiotic-laden cement beads deliver high local concentrations without systemic drug toxicities.…”

“…6 Despite these measures, 20% of patients with abdominal graft infection will have recurrent infection. [7][8][9] Diffusion of a high-concentration antibiotic into the infected field from implanted beads may be a useful adjunct to prevent graft reinfection.…”

“…12 In addition, the antibiotics should be active in the supplied form without requiring in vivo metabolic activation. On the basis of our experience of the broad microbial spectrum found on abdominal aortic graft cultures, 9 we favor antibiotics that provide maximal antibacterial coverage, including anaerobes. Tobramycin is an aminoglycoside antibiotic with bactericidal activity against gramnegative bacteria, including Pseudomonas.…”

“…The most common organisms isolated from infected abdominal aortic grafts in the literature and from our experience include MRSA, Staphylococcus non-aureus sp, Enterococcus sp, Streptococcus sp, and Klebsiella sp. 8,9,16 Fungus was isolated in 13% to 18% of reported cases. 8,9 The addition of an antifungal agent should be considered especially in cases of graft-enteric connections.…”

“…8,9,16 Fungus was isolated in 13% to 18% of reported cases. 8,9 The addition of an antifungal agent should be considered especially in cases of graft-enteric connections. The clinical rationale for combining meropenem with tobramycin was to provide additional enhanced antimicrobial activity for drug-resistant Pseudomonas and other gram-negative bacteria.…”