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Stephanie Thomas Consultant Microbiologist Wythenshawe Hospital. Early & Late Onset Vascular Graft Infection Microbiology aspects. prosthetic vascular graft infection (PVGI). incidence 1 – 6 % (infra-inguinal 2-5%, aortofemoral 1-2%, aortic 1%) relative risk low
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Early & Late Onset Vascular Graft Infection
(infra-inguinal 2-5%, aortofemoral 1-2%, aortic 1%)
(up to 75% with intra-abdominal aortic grafts)
(limb amputation rates up to 70% for lower extremity grafts)
significant complication of arterial reconstruction
early (acute) onset:< 4 months post operative
late onset:> 4 months post operative
more pragmatic approach for diagnosis, predicting microbial aetiology and treatment regimes
*Seabrook et al, 1990, J Vasc Surg
National aggregated data on Surgical Site Infections (2004-09)
[33 hospitals (voluntary), 7,349 operations]
Bandyk et al Arch Surg (1990)
S. epidermidis the infecting organism >60% of aortofemoral graft infections
Kaebnick HW et al, Surgery (1987)
S. epidermidis isolated from 75% of prostheses revised for
anastomotic pseudoaneurysm and 80% of aortofemoral prostheses
removed because of infection
Macbeth GS et al, J Vasc Surg (1984)
S. epidermidis cultured from diseased arterial walls and groin lymph
nodes in one third patients undergoing vascular prosthesis
ubiquitous group, low virulence, significant pathogens in biomaterial-related infections
exopolysaccharide/ biofilm production (slime)
source of infection: contact with prosthetic surface during implantation (c.f.PJI, PVIE)
chronic inflammatory response adjacent to the graft
autolysis of peri-graft tissue and adjacent arterial wall
perigraft exudate, fluid collection
in time decreases the anastomotic tensile strength of anastomotic graft-artery interface
slime producing strain of S.epidermidis colonising fibres of a dacron vascular graft
persistance – sinus formation - pseudoaneurysm
late graft failure
Zetrenne E, Bryan M, McIntosh B et al. (2007)
evolved over 40 years
there is no correlation between the microbiological data and the location or type of vascular infection.
thus, the post operative intravenous antibiotherapy should be bactericidal with broad spectrum.
after obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherance agent, such as rifampicin in staphylococcal infections.