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Infected prosthetic dialysis arteriovenous grafts: a single dialysis center study
Petr Bachleda1, Lucie Kalinova, Petr Utikal
12nd Surgery Clinic, Palacky University Olomouc, Olomouc, Czech Republic.
Background:
The prosthetic arteriovenous grafts (AVG) being used increasingly to create hemodialysis access are prone to infections that pose potentially life-threatening infectious and bleeding complications, as well as loss of dialysis access. In this study, we identified the bacteriologic agents of infected AVGs by site swab, blood culture, and prosthesis cultures, and to evaluate the role of microbiological findings in the management of the infection.
Methods:
We focused on 51 patients with 53 AVGs operated on in our clinic from January 2006 to December 2009. An infected AVG was identified by clinical, ultrasound, and microbiological findings. Sensitivity to antibiotics was determined for all bacterial strains. Isolates were identified by pulsed-field gel electrophoresis (PFGE) of bacterial DNA. In a few cases, positron emission tomography-computed tomography (PET-CT) examination was performed.
Results:
Strains of Staphylococcus spp., especially S. aureus, were the most frequent cause of infected AVG. All S. aureus strains were sensitive to methicillin. With the exception of a single case, isolates obtained simultaneously from the skin site and the vascular prosthesis were identical genetically.
Conclusions:
Our results suggest that bacterial infectious agents detected in site swab, blood, or graft culture confirm a suspicion of AVG infection. A PET-CT examination can provide confirmation. The combination of microbiologic and radionuclide findings can improve the management of the AVG infection, but surgery remains essential.
Insights
Infections in arteriovenous grafts (AVG) for hemodialysis are often caused by Staphylococcus aureus. Microbiological testing and imaging like PET-CT can aid management, but surgery remains crucial for infected AVG.
Area of Science:
- Nephrology
- Infectious Diseases
- Vascular Surgery
Background:
- Prosthetic arteriovenous grafts (AVGs) are increasingly used for hemodialysis access.
- AVG infections lead to serious complications, including bleeding, sepsis, and loss of access.
- Identifying causative agents is crucial for effective management.
Purpose of the Study:
- To identify the bacteriologic agents responsible for infected AVGs.
- To evaluate the role of microbiological findings in managing AVG infections.
- To assess the utility of PET-CT in diagnosing AVG infections.
Main Methods:
- Analysis of 51 patients with 53 AVGs from January 2006 to December 2009.
- Infection diagnosis based on clinical, ultrasound, and microbiological data.
- Bacterial identification, antibiotic sensitivity testing, and DNA fingerprinting (PFGE); PET-CT used in select cases.
Main Results:
- Staphylococcus spp., particularly S. aureus, were the most common pathogens.
- All identified S. aureus strains were methicillin-sensitive.
- Genetic analysis confirmed isolates from skin and prosthesis were typically identical.
Conclusions:
- Microbiological cultures (site swab, blood, prosthesis) confirm AVG infections.
- PET-CT can provide supplementary diagnostic confirmation.
- Combining microbiological and imaging findings improves management, though surgical intervention is essential.
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