A changing pattern of infection after major vascular reconstructions

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Medical Microbiology

Background:

• Wound and graft infections complicate vascular reconstructions for peripheral arterial disease (PAD), with rates potentially exceeding 40%.
• Recent trends show an increase in infection frequency and severity, alongside shifts in causative microorganisms.
• This study investigates factors associated with wound/graft infections in PAD patients.

Purpose of the Study:

• To retrospectively analyze wound and graft infections following vascular reconstructions for PAD.
• To identify patient demographics, graft characteristics, and procedural factors associated with infection development.
• To understand the changing patterns of microorganisms involved in these infections.

Main Methods:

• Retrospective case-controlled study reviewing medical records of 410 vascular reconstructions for PAD over 36 months.
• Infections classified using modified CDC criteria (superficial, deep, graft-involving).
• Univariate and multivariate regression analyses employed to identify risk factors.

Main Results:

• Overall infection rate was 11.0% (45/410), with 80% occurring after infrainguinal reconstructions.
• Groin incisions were involved in 64% of infections; 67% directly involved the graft.
• Staphylococcus aureus was the most common pathogen (64%), particularly in graft disruption cases.
• Risk factors included previous hospitalization, younger age, and groin incisions.
• Nonautogenous grafts had higher infection and anastomotic disruption rates.

Conclusions:

• Infection rates, morbidity, and mortality in vascular reconstructions for PAD are rising, particularly for infrainguinal procedures with groin incisions.
• Perioperative antibiotic strategies should target Staphylococcal species.
• Minimizing pre-operative hospitalization is advisable.