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Coagulase-negative staphylococcal infections in vascular surgery: epidemiology and pathogenesis
C E Edmiston1, D D Schmitt, G R Seabrook
1Department of Surgery, Medical College of Wisconsin, Milwaukee.
Abstract:
Staphylococcal infection of a vascular prosthesis is a relatively uncommon complication of peripheral vascular surgery; however, these infections and their sequelae can be catastrophic. The majority of prosthetic graft infections are caused by mucin-producing strains of Staphylococcus epidermidis, which express varying degrees of adherence to the synthetic substrates. Studies have demonstrated that the components and construction characteristics of the graft, implantation site, administration of antimicrobial agents, and endogenous microbial flora are all identifiable risk factors in vascular graft infections. Mucin production, a known virulence factor, has recently been shown to occur in endogenous coagulase-negative staphylococci (CNS) at the time of hospital admission. While mucin production plays an important role in the persistence of graft infections, there is no evidence that suggests a relationship between mucin and antimicrobial resistance. Identifying characteristics of (CNS) graft infections may include a draining wound sinus, poor graft incorporation, a perigraft exudate or a pseudoaneurysm at the anastomotic site. The occult nature of these infections, in which the patient is often asymptomatic, makes diagnosis and treatment difficult. The graft or graft exudate may be negative when routine culture methods are employed. The recognition of CNS graft infections requires a high index of suspicion and the treatment of these infections requires understanding of the pathogenic process, individualized surgical management, and the judicious use of antimicrobial agents.
Insights
Staphylococcal infections in vascular grafts, often caused by Staphylococcus epidermidis, pose serious risks. Early recognition and tailored treatment are crucial for managing these difficult-to-diagnose graft infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Microbiology
Background:
- Staphylococcal infections are uncommon but severe complications following peripheral vascular surgery.
- Coagulase-negative staphylococci (CNS), particularly Staphylococcus epidermidis, are the primary cause of prosthetic graft infections.
- Factors like graft characteristics, implantation site, and antimicrobial use influence infection risk.
Purpose of the Study:
- To review the characteristics, diagnosis, and management of coagulase-negative staphylococci (CNS) infections in vascular grafts.
- To highlight the role of mucin production as a virulence factor in graft persistence.
Main Methods:
- Literature review of Staphylococcal graft infections.
- Analysis of risk factors, clinical presentation, and diagnostic challenges.
- Discussion of treatment strategies including surgical and antimicrobial approaches.
Main Results:
- Mucin production by Staphylococcus epidermidis contributes to graft infection persistence but not antimicrobial resistance.
- Clinical signs include draining sinuses, poor graft incorporation, exudates, or pseudoaneurysms.
- Diagnosis is challenging due to occult presentation and potential for negative routine cultures.
Conclusions:
- Recognizing CNS graft infections requires a high index of suspicion.
- Effective treatment necessitates understanding pathogenesis, individualized surgical plans, and appropriate antimicrobial use.