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The necessity for long-term antibiotic therapy with positive arterial wall cultures
J M Malone1, S G Lalka, K E McIntyre
1University of Arizona Health Science Center.
Abstract:
The results of treatment after excision of infected arterial grafts were analyzed as a function of aortic/arterial wall cultures and duration of antibiotic therapy in 33 patients. Four patients died during surgery and 29 patients were observed for periods ranging from 2 weeks to 76 months. Negative arterial wall cultures (NAwC) were found in 16 patients, three of whom died of multiple-organ failure and sepsis but none of whom had aortic/arterial disruption/hemorrhage. Positive arterial wall cultures (PAwC) were found in 13 patients, seven of whom received short-term, broad-spectrum antibiotics for less than 10 days (PAwC-STA) and six of whom received long-term culture-specific antibiotic therapy (intravenous therapy for 6 weeks and oral therapy for 6 months) (PAwC-LTA). Five of seven patients in the PAwC-STA group died of aortic disruption or hemorrhage, one patient had severe hemorrhage caused by disintegration of a saphenous vein patch over the common femoral artery, and one patient had a recurrent aortoenteric fistula. There were 10 episodes of arterial disruption/hemorrhage in those seven patients. All episodes of aortic/arterial disruption/hemorrhage occurred in the PAwC-STA subgroup (seven of seven patients) and none occurred in the PAwC-LTA subgroup (none of six patients) (0.005 less than p less than 0.001). The incidence of aortic/arterial disruption/hemorrhage was significantly different between overall PAwC (7 of 13 patients) vs NAwC (none of 16 patients) (0.005 less than p less than 0.001) and NAwC-STA (none of 16 patients) vs PAwC-STA (seven of seven patients) (0.001 less than p less than 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Long-term, culture-specific antibiotics significantly reduced arterial disruption and hemorrhage in patients with infected arterial grafts. Short-term antibiotics in patients with positive arterial cultures led to severe complications and death.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Pharmacology
Background:
- Infected arterial grafts pose significant risks, including graft dehiscence, hemorrhage, and sepsis.
- Treatment strategies often involve graft excision and antibiotic therapy, but outcomes vary.
- The role of arterial wall culture results and antibiotic duration in predicting outcomes remains critical.
Purpose of the Study:
- To analyze treatment outcomes following infected arterial graft excision.
- To investigate the correlation between arterial wall culture status and antibiotic therapy duration with patient outcomes.
- To assess the incidence of aortic/arterial disruption and hemorrhage based on these factors.
Main Methods:
- Retrospective analysis of 33 patients undergoing infected arterial graft excision.
- Categorization based on arterial wall culture results (negative vs. positive).
- Subgroup analysis of positive culture patients based on antibiotic therapy duration (short-term vs. long-term culture-specific).
Main Results:
- Patients with negative arterial wall cultures (NAwC) had no aortic/arterial disruption/hemorrhage.
- Patients with positive arterial wall cultures receiving short-term antibiotics (PAwC-STA) experienced high rates (7/7) of aortic/arterial disruption/hemorrhage, including death.
- Patients with positive arterial wall cultures receiving long-term culture-specific antibiotics (PAwC-LTA) had no such complications (0/6).
Conclusions:
- Positive arterial wall cultures are associated with a significantly higher risk of aortic/arterial disruption/hemorrhage.
- Long-term, culture-specific antibiotic therapy is crucial for preventing severe complications in patients with infected arterial grafts.
- Short-term antibiotic use in patients with positive arterial cultures is associated with catastrophic outcomes.