The necessity for long-term antibiotic therapy with positive arterial wall cultures

Abstract

The results of treatment after excision of infected arterial grafts were analyzed as a function of aortic/arterial wall cultures and duration of antibiotic therapy in 33 patients. Four patients died during surgery and 29 patients were observed for periods ranging from 2 weeks to 76 months. Negative arterial wall cultures (NAwC) were found in 16 patients, three of whom died of multiple-organ failure and sepsis but none of whom had aortic/arterial disruption/hemorrhage. Positive arterial wall cultures (PAwC) were found in 13 patients, seven of whom received short-term, broad-spectrum antibiotics for less than 10 days (PAwC-STA) and six of whom received long-term culture-specific antibiotic therapy (intravenous therapy for 6 weeks and oral therapy for 6 months) (PAwC-LTA). Five of seven patients in the PAwC-STA group died of aortic disruption or hemorrhage, one patient had severe hemorrhage caused by disintegration of a saphenous vein patch over the common femoral artery, and one patient had a recurrent aortoenteric fistula. There were 10 episodes of arterial disruption/hemorrhage in those seven patients. All episodes of aortic/arterial disruption/hemorrhage occurred in the PAwC-STA subgroup (seven of seven patients) and none occurred in the PAwC-LTA subgroup (none of six patients) (0.005 less than p less than 0.001). The incidence of aortic/arterial disruption/hemorrhage was significantly different between overall PAwC (7 of 13 patients) vs NAwC (none of 16 patients) (0.005 less than p less than 0.001) and NAwC-STA (none of 16 patients) vs PAwC-STA (seven of seven patients) (0.001 less than p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Prosthetic vascular infection complicated or not by aortoenteric fistula: Comparison of treatment with and without cryopreserved allograft (homograft)

“…However, for patients without aortoenteric fistula, cryopreserved allografts are very resistant; rupture of the proximal allograft±aortic anastomosis has not been reported. Several authors 20,21 insist on the importance of complete excision at the infected proximal anastomosis. Was our surgical excision too limited?…”

Do infected inguinal lymph nodes increase the incidence of postoperative groin wound infection?

“…The cause could be related to an increase in bacterial colonization of the arterial wall, which has been shown to occur despite apparently adequate antibiotic therapy; perhaps patients with an open lesion should be treated with long-term antibiotic therapy to decrease the incidence of GWI. 7,8,11 An alternative explanation for the increased incidence of GWI in patients with an open lesion is skin contamination that may be reduced by preoperative showering with antiseptic soaps s,13 and possibly by improvements in intraoperafive sterilization. The presence of insulin-dependent diabetes mellitus is a well-known risk factor for GWI/'2J~ Although it is often listed as part of a risk factor index, 2,11,~4 insulin-dependent diabetes was a strong independent predictor of GWI when analyzed by multiple regression analysis (odds ratio 22.9, p = 0.01) in our study.…”

Diagnosis and management of staphylococcal infections of vascular grafts and stents

“…Seven of the 13 culture-positive patients received less than 10 days of antimicrobial therapy while six received 6 weeks of intravenous therapy followed by 6 months of oral treatment. 32 During followup, which ranged from 2 weeks to 76 months, there were 10 episodes of arterial disruption or haemorrhage in those receiving short-term antimicrobial therapy (and 5 deaths), but none in the culture-negative group (P < 0.01) or in the long term treatment group (P < 0.001). It is unclear how long intravenous antimicrobial therapy is needed, and whether it is safe to discontinue therapy before 6 months or whether it should be continued long-term.…”

“…In a 1988 study, stump cultures were found to correlate with graft cultures in only 48% of cases. 32 The outcome was correlated with the presence and treatment of arterial stump organisms, but not the graft culture. Gram's stains of these specimens are frequently negative when cultures are positive.…”