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Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes.

Erb S, Sidler JA, Elzi L, Gurke L, Battegay M, Widmer AF, Weisser M - PLoS ONE (2014)

Bottom Line: Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria.Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections.In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.

ABSTRACT

Objective: Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.

Methods: This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.

Results: Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.

Conclusions: We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.

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Comparison of primary and secondary outcomes in the treatment of prosthetic vascular graft infection.PVGI  =  prosthetic vascular graft infection. *p-value  = 0.006. †p-value  = 0.001. ‡p-value  = 0.004. §p-value  = 0.012. **Removal or replacement of the infected vascular graft. ††No surgical intervention; antimicrobial treatment only.
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pone-0112947-g001: Comparison of primary and secondary outcomes in the treatment of prosthetic vascular graft infection.PVGI  =  prosthetic vascular graft infection. *p-value  = 0.006. †p-value  = 0.001. ‡p-value  = 0.004. §p-value  = 0.012. **Removal or replacement of the infected vascular graft. ††No surgical intervention; antimicrobial treatment only.

Mentions: During the time period covered by the study, 72 patients were identified in the infectious diseases database as possibly having a PVGI (Figure 1). Of these, a total of 11 patients were excluded from the study, 5 because their infections did not meet the study criteria for a PVGI, 1 because there was insufficient outcome data, and 5 because they had hemodialysis-shunt graft infection. The remaining 61 patients with a confirmed PVGI were included in the analysis. In 24 of the analyzed 61 patients, the site of the infection was a thoracic graft (18 of whom with a composite graft and heart valve replacement); in 27 patients, the site of the infection was an abdominal graft (21 an aorto-iliac graft, 6 a graft confined to the abdominal aorta); and in 10 patients, the site of the infection was a peripheral graft. Two patients had an endoluminal graft replacement (1 of them a thoracic graft, and 1 of them an abdominal-iliac graft). In 47 patients, the reason for initially implanting a prosthetic vascular graft was an aneurysm (46 aortic grafts; 1 peripheral graft). In 11 patients, the reason for the graft implant was an occlusive arterial disease (3 aortic grafts; 8 peripheral grafts). In the remaining three patients, the reason for the graft implant was an abscess, a paravalvular leak in another patient and a severe aortic stenosis in the third patient.


Surgical and antimicrobial treatment of prosthetic vascular graft infections at different surgical sites: a retrospective study of treatment outcomes.

Erb S, Sidler JA, Elzi L, Gurke L, Battegay M, Widmer AF, Weisser M - PLoS ONE (2014)

Comparison of primary and secondary outcomes in the treatment of prosthetic vascular graft infection.PVGI  =  prosthetic vascular graft infection. *p-value  = 0.006. †p-value  = 0.001. ‡p-value  = 0.004. §p-value  = 0.012. **Removal or replacement of the infected vascular graft. ††No surgical intervention; antimicrobial treatment only.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4231097&req=5

pone-0112947-g001: Comparison of primary and secondary outcomes in the treatment of prosthetic vascular graft infection.PVGI  =  prosthetic vascular graft infection. *p-value  = 0.006. †p-value  = 0.001. ‡p-value  = 0.004. §p-value  = 0.012. **Removal or replacement of the infected vascular graft. ††No surgical intervention; antimicrobial treatment only.
Mentions: During the time period covered by the study, 72 patients were identified in the infectious diseases database as possibly having a PVGI (Figure 1). Of these, a total of 11 patients were excluded from the study, 5 because their infections did not meet the study criteria for a PVGI, 1 because there was insufficient outcome data, and 5 because they had hemodialysis-shunt graft infection. The remaining 61 patients with a confirmed PVGI were included in the analysis. In 24 of the analyzed 61 patients, the site of the infection was a thoracic graft (18 of whom with a composite graft and heart valve replacement); in 27 patients, the site of the infection was an abdominal graft (21 an aorto-iliac graft, 6 a graft confined to the abdominal aorta); and in 10 patients, the site of the infection was a peripheral graft. Two patients had an endoluminal graft replacement (1 of them a thoracic graft, and 1 of them an abdominal-iliac graft). In 47 patients, the reason for initially implanting a prosthetic vascular graft was an aneurysm (46 aortic grafts; 1 peripheral graft). In 11 patients, the reason for the graft implant was an occlusive arterial disease (3 aortic grafts; 8 peripheral grafts). In the remaining three patients, the reason for the graft implant was an abscess, a paravalvular leak in another patient and a severe aortic stenosis in the third patient.

Bottom Line: Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria.Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections.In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.

ABSTRACT

Objective: Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.

Methods: This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.

Results: Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.

Conclusions: We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.

Show MeSH
Related in: MedlinePlus