Medical treatment of prosthetic vascular graft infections: Review of the literature and proposals of a Working Group

Abstract

More than 400000 vascular grafts are inserted annually in the USA. Graft insertion is complicated by infection in 0.5-4% of cases. Vascular graft infections (VGIs) are becoming one of the most frequent prosthesis-related infections and are associated with considerable mortality, ranging from 10 to 25% within 30 days following the diagnosis. Treatment of VGI is based on urgent surgical removal of the infected graft followed by prolonged antibiotherapy. Data regarding the best antibiotherapy to use are lacking since no well designed trial to study antimicrobial treatment of VGI exists. Moreover, since VGIs demonstrate very specific pathophysiology, guidelines on other material-related infections or infective endocarditis treatment cannot be entirely applied to VGI. A French multidisciplinary group gathering infectious diseases specialists, anaesthesiologists, intensivists, microbiologists, radiologists and vascular surgeons was created to review the literature dealing with VGI and to make some proposals regarding empirical and documented antibiotic therapy for these infections. This article reveals these proposals.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…Therefore, most authors now prefer an in situ reconstruction (ISR) with infection resistant material combined with removal of the infected graft material, aggressive debridement of the arterial bed and targeted antimicrobial therapy. 67,69 In most situations the Recommendation 11 In every case where a vascular graft/endograft is implanted, antimicrobial prophylaxis to cover the first 24 hours, by intravenous administration of a first/second generation cephalosporin or vancomycin in the event of penicillin allergy, is recommended.…”

Serine Protease Inhibitors—New Molecules for Modification of Polymeric Biomaterials

“…Vascular prosthesis infections affect approximately 2-4% of the population of patients, but the frequency of their occurrence depends mainly on the area where the prostheses are located [44]. To reduce the risk of infection, various techniques of synthesis and modification of biomaterials are currently used.…”

Vascular Graft Impregnation with Antibiotics: The Influence of High Concentrations of Rifampin, Vancomycin, Daptomycin, and Bacteriophage Endolysin HY-133 on Viability of Vascular Cells

“…Both antimicrobial agents are broadly used for systemic treatment of vascular graft infections [47,48]. Furthermore, both antibiotics were suggested for preventing graft infections by their local release, including impregnation and soaking techniques [13,15,49–52].…”