Primary graft infections

Abstract

An amputation rate of 8% to 52% and a mortality rate of 13% to 58% make vascular prosthetic graft infections the most dreaded complication facing a vascular surgeon. In 1978 a randomized prospective double-blind study reported a statistically significant decrease in wound infections in patients treated with prophylactic antibiotics whereas the graft infection difference only approached statistical significance. The present study reviews 2614 arterial prosthetic grafts implanted from January 1975 through June 1986. Twenty-four patients were identified as having a prosthetic graft infection, yielding an overall infection rate of 0.92%. Staphylococcus aureus was the most common organism, occurring in one third of the cases. The most common graft material was polytetrafluoroethylene (PTFE) (33%) followed by Dacron (29%), composite PTFE and Dacron (20%), and umbilical vein grafts (9%). Diabetes was a common factor in one third of the patients. Symptoms of infection were present in 15 patients (63%) within 3 months of operation, with 11 patients showing symptoms within 30 days. The longest interval between operation and onset of symptoms was 48 months. Prophylactic antibiotics were administered to 22 of the 24 patients, but in only 7 of the 22 (29.5%) were they given according to our usual practice. All patients required removal of the infected prosthesis, with limb loss in 17% and death in 17%.

Prosthetic graft infections involving the femoral artery

“…11 However, prior studies looking at graft infections have not analyzed if graft infection is an independent predicator of major lower extremity amputation. 4,5,10,11 Cryopreserved veins are an alternative conduit option to avoid amputation that has been reported with some success. 19 We did not use it in this study period, however we have subsequently used it with short term success.…”

“…2, 3 These surgical site infections occasionally lead to graft infection with rates of post-operative amputation and mortality as high as 52% and 58% respectively having been reported. 4 These prosthetic graft infections are not infrequent with a reported incidence of up to 4.7%. 5 Aside from the adverse effect on the patient, post-operative vascular surgical infections significantly contribute to health care costs, as they often require additional procedures and a lengthier inpatient stay.…”

“…6 Reported treatments include removal of the graft as well as graft preservation with the use of vacuum assisted closure (VAC) devices, with or without muscle flap coverage. 4, 7–9 Recently the trend has been to move away from graft removal with the latter options more commonly employed. 7–9 …”

“…Prior larger studies that have specifically looked at infected prosthetic grafts were conducted before the identification of Methicillin-resistant Staphylococcus aureus (MRSA), did not stratify by wound location or operative indication, and did not perform statistical analysis to determine risk factors. 4, 10, 11 Other previous analyses had a small sample size and included vein grafts in their analysis with only a small proportion of the cases involving prosthetic grafts. 5, 12, 13 …”

Complicação infecciosa indica mau prognóstico no infarto agudo do miocárdio

“…This phenomenon may reflect a higher prevalence of other diseases, such as comorbidities, among patients admitted with AMI. In fact, some studies have already identified a higher prevalence of diabetes mellitus associated with AMI 3 , which in turn may increase the incidence of infectious complications in AMI, as with other diseases that affect elderly and/or diabetic patients 4,5,6,7 .…”