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The impact of multiple operations on the importance of arterial wall cultures
Abstract:
The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (chi 2 = 5.84; 0.01 less than p less than 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)--a culture obtained at initial vascular reconstruction--and group II (40 patients)--a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; chi 2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; chi 2 = 4.68; 0.025 less than p less than 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of high-dose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.
Insights
Positive arterial cultures predict prosthetic graft infection in repeat vascular surgery patients, but not in initial reconstructions. Routine cultures are not recommended for initial surgeries; however, they are advised for subsequent procedures to guide treatment decisions.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Medical Microbiology
Background:
- Prosthetic graft infections pose a significant risk following vascular reconstructions.
- The role of arterial cultures in predicting graft infection requires further clarification, especially differentiating between initial and subsequent procedures.
Purpose of the Study:
- To evaluate the predictive value of arterial cultures for prosthetic graft infection in patients undergoing major vascular reconstructions.
- To determine if the timing of arterial culture (initial vs. subsequent surgery) influences its association with graft infection.
Main Methods:
- Retrospective review of arterial culture data from 172 patients undergoing major vascular reconstructions between 1977 and 1984.
- Patients were stratified into two groups: initial vascular reconstruction (Group I) and subsequent vascular reconstruction (Group II).
- Statistical analysis (chi-squared test) was used to compare infection rates between positive and negative arterial cultures within each group.
Main Results:
- Positive arterial cultures were associated with a significantly higher incidence of prosthetic graft infection (8% vs. 0%, p<0.025).
- Arterial cultures had no predictive value for graft infection in patients undergoing initial reconstruction (Group I).
- Positive arterial cultures were significantly associated with increased graft infection rates in patients undergoing subsequent reconstructions (Group II, p<0.05).
Conclusions:
- Routine arterial cultures are not indicated for initial vascular reconstructions.
- Arterial cultures are recommended for subsequent vascular reconstructions to assess infection risk.
- Positive cultures in subsequent reconstructions warrant prompt antibiotic treatment, with continued long-term oral antibiotics possibly beneficial.