Use of rifampicin and graft removal are associated with better outcomes in prosthetic vascular graft infection

Coste, Anne; Poinot, M; Panaget, Sophie; Albert, Bénédicte; Kaladji, Adrien; Bars, Hervé Le; Nasr, Bahaa; Badra, Ali; Piau, Caroline; Cattoir, Vincent; Moreuil, Claire de; Revest, Matthieu; Berre, Rozenn Le

doi:10.1007/s15010-020-01551-z

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…In our study, S aureus was the most frequently found bacteria in blood cultures and intraoperative samples, which may be in a third of cases resistant to methicillin. This microbiological distribution is also observed in several other studies [ 14 , 19 , 33 ].…”

Section: Discussionsupporting

confidence: 88%

“…By contrast, a recent study reported that graft removal was associated with better 1-year survival [ 14 ]. While this suggests that surgery has an impact in the first few years after infection, this early beneficial effect of surgery may be counterbalanced over time by the weight of patient comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies in the current literature focus on surgical management, and they are often limited by their population size (range, 43–143 patients [ 13 , 14 ]). There is also a great disparity in management between studies.…”

mentioning

confidence: 99%

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Long-term Prognosis Following Vascular Graft Infection: A 10-Year Cohort Study

Sixt¹,

Aho²,

Chavanet

et al. 2022

Open Forum Infectious Diseases

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Background Vascular graft infection remains a severe disease with high mortality and relapse rates. We performed a retrospective single center cohort study to highlight factors associated with long-term all-cause mortality in patients with vascular graft infection. Methods All patients hospitalized in our facility over 10 years for a vascular graft infection (VGI) were included. VGI was defined by the presence of a vascular graft or an aortic stent graft (stent or fabric), associated with two criteria among clinical, biological, imaging, or microbiological elements in favor of VGI. The primary outcome was all-cause mortality. Empirical antibiotic therapy was considered as appropriate when all involved pathogens were susceptible in vitro to the antibiotics used. The surgical strategy was defined as non-optimal when the graft was not removed in a late-onset surgery (>3 months) or no surgery was performed. Results One hundred and forty-six patients were included. Empirical antibiotic therapy was administered in 98 (67%) patients and considered appropriate in 55 (56%) patients. Surgery was performed in 136 patients (96%) and considered as optimal in 106 (73%) patients. In multivariable analysis, appropriate empirical antibiotic therapy was associated with a lower probability of mortality (Hazard Ratio=0.47; 95% Confidence Interval: 0.30-0.79; p=.002). Long term survival did not differ according to whether the surgical strategy was considered optimal or not (log rank=.66). Conclusion Appropriate empirical antibiotic therapy is a cornerstone of the management of vascular graft infection. Whenever possible, antibiotics must be associated with optimal surgical management. However, surgery could potentially be avoided in comorbid patients who are treated with appropriate antibiotics.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Long-term Prognosis Following Vascular Graft Infection: A 10-Year Cohort Study

Sixt¹,

Aho²,

Chavanet

et al. 2022

Open Forum Infectious Diseases

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“…This is in contrast to the 16% cure rate we found, although there was a significant decrease in median bacterial load on grafts (3.50 vs. 6.56, p = 0.0016). While these results are from animal models on implant-associated osteomyelitis, there are clinical data supporting rifampicin combinations for PVGI [ 36 ]. Further studies are needed in order to clarify, which antibiotics benefit the most from rifampicin for acute PVGI caused by staphylococci.…”

Section: Discussionmentioning

confidence: 99%

Fibrinolytic and antibiotic treatment of prosthetic vascular graft infections in a novel rat model

et al. 2023

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Objectives We developed a rat model of prosthetic vascular graft infection to assess, whether the fibrinolytic tissue plasminogen activator (tPA) could increase the efficacy of antibiotic therapy. Materials and methods Rats were implanted a polyethylene graft in the common carotid artery, pre-inoculated with approx. 6 log10 colony forming units (CFU) of methicillin resistant Staphylococcus aureus. Ten days after surgery, rats were randomized to either: 0.9% NaCl (n = 8), vancomycin (n = 8), vancomycin + tPA (n = 8), vancomycin + rifampicin (n = 18) or vancomycin + rifampicin + tPA (n = 18). Treatment duration was seven days. Approximately 36 hours after the end of treatment, the rats were euthanized, and grafts and organs were harvested for CFU enumeration. Results All animals in the control group had significantly higher CFU at the time of euthanization compared to bacterial load found on the grafts prior to inoculation (6.45 vs. 4.36 mean log10 CFU/mL, p = 0.0011), and both the procedure and infection were well tolerated. Vancomycin and rifampicin treatment were superior to monotherapy with vancomycin, as it lead to a marked decrease in median bacterial load on the grafts (3.50 vs. 6.56 log10 CFU/mL, p = 0.0016). The addition of tPA to vancomycin and rifampicin combination treatment did not show a further decrease in bacterial load (4.078 vs. 3.50 log10 CFU/mL, p = 0.26). The cure rate was 16% in the vancomycin + rifampicin group vs. 37.5% cure rate in the vancomycin + rifampicin + tPA group. Whilst interesting, this trend was not significant at our sample size (p = 0.24). Conclusion We developed the first functional model of an arterial prosthetic vascular graft infection in rats. Antibiotic combination therapy with vancomycin and rifampicin was superior to vancomycin monotherapy, and the addition of tPA did not significantly reduce bacterial load, nor significantly increase cure rate.

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“…Whether it is beneficial to combine other antibiotics with rifampicin to specifically target S. aureus persister cells is currently unknown. Interestingly, retrospective studies on VGEI found a significantly lower risk of treatment failure if rifampicin was administered with an OR of 0.3 (95% CI: 0.09–0.87, 95% CI, p = 0.04) and OR 0.32 (95% CI: 0.10–0.96; p = 0.04), yet such studies inherently risk bias in the form of confounding by indication, making it impossible to ascertain if the effect is caused by rifampicin enhanced killing of persister cells [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of rifampicin combination therapy against MRSA prosthetic vascular graft infections in a rat model

Johansen,

Petersen,

Faddy

et al. 2024

Biofilm

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Use of rifampicin and graft removal are associated with better outcomes in prosthetic vascular graft infection

Cited by 8 publications

References 24 publications

Long-term Prognosis Following Vascular Graft Infection: A 10-Year Cohort Study

Long-term Prognosis Following Vascular Graft Infection: A 10-Year Cohort Study

Fibrinolytic and antibiotic treatment of prosthetic vascular graft infections in a novel rat model

Efficacy of rifampicin combination therapy against MRSA prosthetic vascular graft infections in a rat model

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