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Primary graft infections
Abstract:
An amputation rate of 8% to 52% and a mortality rate of 13% to 58% make vascular prosthetic graft infections the most dreaded complication facing a vascular surgeon. In 1978 a randomized prospective double-blind study reported a statistically significant decrease in wound infections in patients treated with prophylactic antibiotics whereas the graft infection difference only approached statistical significance. The present study reviews 2614 arterial prosthetic grafts implanted from January 1975 through June 1986. Twenty-four patients were identified as having a prosthetic graft infection, yielding an overall infection rate of 0.92%. Staphylococcus aureus was the most common organism, occurring in one third of the cases. The most common graft material was polytetrafluoroethylene (PTFE) (33%) followed by Dacron (29%), composite PTFE and Dacron (20%), and umbilical vein grafts (9%). Diabetes was a common factor in one third of the patients. Symptoms of infection were present in 15 patients (63%) within 3 months of operation, with 11 patients showing symptoms within 30 days. The longest interval between operation and onset of symptoms was 48 months. Prophylactic antibiotics were administered to 22 of the 24 patients, but in only 7 of the 22 (29.5%) were they given according to our usual practice. All patients required removal of the infected prosthesis, with limb loss in 17% and death in 17%.
Insights
Vascular prosthetic graft infections are severe complications. This study found an infection rate of 0.92% in 2614 grafts, with Staphylococcus aureus being common and leading to high amputation and mortality rates.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Biomaterials
Background:
- Vascular prosthetic graft infections are a serious complication with high amputation and mortality rates.
- Previous studies suggested prophylactic antibiotics may reduce infection rates, but evidence was limited.
Purpose of the Study:
- To determine the incidence and characteristics of vascular prosthetic graft infections.
- To analyze outcomes in patients with infected grafts.
Main Methods:
- Retrospective review of 2614 arterial prosthetic grafts implanted between January 1975 and June 1986.
- Identification and analysis of 24 cases of prosthetic graft infection.
Main Results:
- Overall infection rate was 0.92%. Staphylococcus aureus was the most common pathogen.
- Polytetrafluoroethylene (PTFE) and Dacron were the most frequent graft materials. Diabetes was a common comorbidity.
- Infected grafts required prosthesis removal, resulting in 17% limb loss and 17% mortality. Many infections presented within 3 months of surgery.
Conclusions:
- Vascular prosthetic graft infections remain a significant challenge with severe consequences.
- While prophylactic antibiotics were often used, their administration varied, potentially impacting efficacy.
- Infection necessitates graft removal, leading to high rates of limb loss and mortality.