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A Delayed Inoculation Model of Chronic Pseudomonas aeruginosa Wound Infection
Published on: February 20, 2020
Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with
Yuan-Hsi Tseng1, Chien-Chao Lin2, Min Yi Wong2,3
1Division of Thoracic and Cardiovascular Surgery, New Taipei Municipal TuCheng Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan.
Abstract:
Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray's test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.
Insights
Pseudomonas aeruginosa (PA) infections in arteriovenous grafts (AVGs) show higher recurrence rates after subtotal excision or revision. Revision surgery alone may increase AVG infection recurrence risk.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Arteriovenous graft (AVG) infections pose a significant challenge in hemodialysis access.
- Pseudomonas aeruginosa (PA) is a common pathogen in AVG infections, but its impact on recurrence is debated.
Purpose of the Study:
- To investigate the recurrence rate of Pseudomonas aeruginosa (PA) infections in arteriovenous grafts (AVGs) compared to other bacterial infections.
- To identify factors influencing the recurrence of AVG infections after surgical intervention.
Main Methods:
- A retrospective study of 60 patients with 65 AVG infections treated with total excision, subtotal excision, or revision.
- Cumulative incidence function and Gray's test were used for competing risk analysis.
- Subdistribution hazard (SDH) models assessed associations between variables and infection recurrence.
Main Results:
- PA infection was not initially associated with higher recurrence (p=0.13), but operative procedure type was (p=0.04).
- AVGs with PA infection required more surgical interventions.
- One year post-surgery, recurrent infection incidence was 3.3-fold higher for PA infections with subtotal excision/revision and 4.1-fold higher with revision alone.
- After excluding total excision, PA infection significantly increased recurrence risk (SDH HR=16.05, p=0.02).
Conclusions:
- Arteriovenous graft infections with Pseudomonas aeruginosa have a higher recurrence rate following subtotal resection and revision compared to other bacterial infections.
- Revision surgery alone may exacerbate the risk of AVG infection recurrence.
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