Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin

Abstract

BackgroundThere exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).MethodsAll data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.Results84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].ConclusionResults of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.

In vitro Evidence of Improved Antimicrobial Efficacy of Silver and Triclosan Containing Vascular Grafts Compared with Rifampicin Soaked Grafts

“…Subsequently, this strategy exposes patients to host rifampicin resistant mutants, which is a disastrous consequence since combination therapies using rifampicin are frequently prescribed to conservatively or post-operatively treat patients with infected vascular grafts. For instance, in a cohort of 84 patients with staphylococcal vascular graft infection, Legout et al 26 have reported that antibiotic combination therapy containing rifampicin had better outcome than combinations without rifampicin (OR 0.32, 95% CI 0.10e0.96; p ¼ .04). Although resistance to triclosan/silver or silver alone was not observed in the experiments, this could potentially arise as is the case for all selection pressures.…”

Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

“…This study shows that patients with abdominal PVGI in particular tended to have unfavorable long-term outcomes, and patients with thoracic PVGI tended to have significantly better outcomes. This observation can be partly explained by the fact that patients with abdominal PVGI frequently had renal impairment (48.1%), which has been shown to be a predictor of treatment failure in PVGI [34] . In addition, abdominal PVGI was often the result of an intra-abdominal, polymicrobial infection (e.g.…”

Controversy about the Role of Rifampin in Biofilm Infections: Is It Justified?

“…Based on our observation that rifampin could not only prevent, but also cure experimental staphylococcal implant-associated infections [15], we performed additional animal experiments with rifampin combination therapy [16], followed by observational studies and one randomized controlled trial in patients with orthopedic implant-associated infections [7,[17][18][19]. Later, rifampin combination therapy has shown to improve the outcome in patients with other types of implant-associated infections such as staphylococcal prosthetic valve endocarditis [14,20], deep sternal wound infections [21] and vascular graft associated infections [22,23]. However, data from randomized controlled trials are still not available in patients with non-orthopedic implant-associated infections.…”