Vascular surgical site infection: risk factors and preventive measures

Surgical-site infection (SSI) after arterial intervention is the most common nosocomial vascular infection and an important cause of postoperative morbidity. Its prevention requires the vascular surgeon to be cognizant of its changing epidemiology, patient risk factors, and effective measures to reduce its incidence. The majority of vascular SSIs are caused by Gram-positive bacteria, and methicillin-resistant Staphylococcus aureus has emerged as the prevalent pathogen, now involved in more than one-third of cases. Nasal carriage of methicillin-sensitive or methicillin-resistant S. aureus strains, recent hospitalization, failed arterial reconstruction, and presence of a groin incision, are major risk factors for developing vascular SSI. Overall, the vascular SSI rate is higher than predicted by Center for Disease Control National Nosocomial Infections Surveillance risk category system, and ranges from 1% to 2% after open or endovascular aortic interventions to as high as 10% to 20% after lower-limb bypass grafting procedures. Use of preoperative measures to reduce S. aureus nasal and skin colonization in conjunction with appropriate, bactericidal antibiotic prophylaxis, meticulous wound closure, and postoperative care to optimize patient host defense regulation mechanisms (temperature, oxygenation, blood sugar) can minimize SSI occurrence.