Vascular Surgical Antibiotic Prophylaxis Study (VSAPS)

Chisci

et al. 2014

aorta

The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.

Section: Surgical Treatmentmentioning

confidence: 99%

How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair

Chisci

et al. 2014

aorta

Journal of Vascular Surgery

“…Although many are outdated, a number of studies have investigated the utility of systemic prophylactic antibiotics in vascular surgery, and a variety of systemically administrated antibiotics, singly or in combination, have been proposed. [17][18][19][20] Only a few studies have investigated antimicrobial graft materials, predominantly containing topical antibiotics and some using topical antiseptics. In recent decades, various concepts for antimicrobial grafts have been developed to prevent vascular graft infection.…”

mentioning

confidence: 99%

In vitro evaluation of the antimicrobial efficacy of a new silver-triclosan vs a silver collagen-coated polyester vascular graft against methicillin-resistant Staphylococcus aureus

Ricco

Assadian

Schneider

et al. 2012

Both antimicrobial collagen-coated polymer vascular grafts showed bactericidal activity against methicillin-resistant Staphylococcus aureus in vitro. Although the silver-triclosan vascular graft showed a faster antimicrobial efficacy, the silver graft exhibited its antimicrobial properties after 24 hours. Which concept will protect an implanted vascular prosthetic graft better from bacterial contamination and subsequent infection needs to be investigated further in in vivo animal and clinical studies.

“…Our previous randomized study permitted multiple surgical site incisions and likely diluted and provided more heterogeneity because neck and arm incisions are less frequently complicated by site infections. 7 …”

Section: Discussionmentioning

confidence: 99%

“…6 With this evolving microbial climate, we attempted to address this question several years ago with a prospective randomized trial comparing Cefazolin alone to Cefazolin with the addition of either vancomycin or daptomycin. 7 The infection rate was lowest in those receiving a combination of Cefazolin and Daptomycin; however, sample size was small and other methodological issues were identified. With the increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections 4,5 compared with historical series, in addition to a single center design and enrollment challenges we felt a third arm with the current standard of care would be difficult to fulfill patient enrollment in a reasonable time frame.…”

mentioning

confidence: 98%

Prospective Randomized Double-blinded Trial Comparing 2 Anti-MRSA Agents With Supplemental Coverage of Cefazolin Before Lower Extremity Revascularization

et al. 2015

Self Cite

Objective To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion. Background Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections? Methods Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days. Results Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in 1(1.18%)/0(0%) of Vancomycin patients and 9 (9.68%)/1 (1.08%) of Daptomycin patients, respectively (P < 0.02 and P = 1.00). Readmissions related to surgical site infections occurred in 4(4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (P = 0.11). Patients undergoing operative exploration occurred in 5 (5.88%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (P = 0.17). Late infections were reported in 3 patients, 2 of which were in the combined Daptomycin group. Median hospital charges related to readmissions due to a surgical site infection was $50,823 in the combination Vancomycin arm and $110,920 in the combination Daptomycin group; however, no statistical significance was appreciated (P = 0.11). Conclusions Vancomycin supplemental prophylaxis seems to reduce the incidence of Gram-positive infection compared with adding supplemental Daptomycin prophylaxis. The Incidence of MRSA-related surgical site infections is low with the addition of either anti-MRSA agents compared with historical incidence of MRSA-related infection.