[Long-term antibiotic suppressive therapy for an infected thoracic aorta graft]

Infections of arterial vascular grafts are among the most dreaded complications in vascular surgery. Infection in a thoracic aorta graft poses particular challenges. Depending on the local anatomy, extraanatomic bypass, otherwise the cornerstone in the management of infected vascular grafts, is usually impossible.

We present a case report on a patient with an infected thoracic aorta graft and discuss the choice of antibiotics for long-term suppressive therapy.

In the course of the 52 months since the insertion of the aortic graft, the patient experienced eight serious episodes of staphylococcal septicaemia, with Staphylococcus aureus in blood culture on each occasion. A combination therapy of three orally administered anti-staphylococcal antibiotics has kept him free from recurrent septic episodes over the last 25 months, with a good quality of life and without signs of systemic infection.

Life-long antibiotic suppressive therapy for infected thoracic aorta graft offers the prospect of long-term survival with a good quality of life, even when there are recurrent serious septic complications. The choice of antibiotics should take into account the feasibility of the proposed treatment; parenteral antibiotics are not a realistic option in the long run. The antibiotics should be well absorbed after oral administration, have a high intrinsic activity against the offending pathogen, and be given at intervals leading to inhibitory blood concentrations throughout most of the day. In our patient, a triple combination therapy was necessary.