Vascular surgical site infection: risk factors and preventive measures

Surgical site infection (SSI) after arterial intervention is a common nosocomial vascular complication and an important cause of postoperative morbidity. Its prevention requires the vascular surgeon and the health care team to be cognizant of its epidemiology and patient-specific risk factors to apply effective measures to reduce the incidence. The majority of vascular SSIs are caused by Gram-positive bacteria with methicillin-resistant Staphylococcus aureus (MRSA) now a prevalent pathogen that is involved in more than one-third of cases. Nasal carriage of methicillin-sensitive S. aureus or MRSA strains, recent hospitalization, a failed arterial reconstruction, and the presence of a groin incision are major risk factors for developing a vascular SSI. Overall, the SSI rate after arterial intervention is higher than predicted by the Centers for Disease Control and Prevention's 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. Application of perioperative 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 (eg, temperature, oxygenation, and blood sugar) can minimize SSI occurrence.