Conservative treatment of vascular prosthetic graft infection is associated with high mortality

Saleem, Ben R.; Meerwaldt, Robbert; Tielliu, Ignace F.J.; Verhoeven, Eric L.G.; van den Dungen, Jan J.A.M.; Zeebregts, Clark J.

doi:10.1016/j.amjsurg.2009.05.018

« Previous Next »The American Journal of Surgery
Volume 200, Issue 1 , Pages 47-52, July 2010

Conservative treatment of vascular prosthetic graft infection is associated with high mortality

Ben R. Saleem, M.D.
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
Robbert Meerwaldt, M.D., Ph.D.
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
Ignace F.J. Tielliu, M.D.
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
Eric L.G. Verhoeven, M.D., Ph.D.
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
Jan J.A.M. van den Dungen, M.D., Ph.D.
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
Clark J. Zeebregts, M.D., Ph.D.
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Corresponding author. Tel.: 31-503613382; fax: 31-503611745

Received 17 January 2009; received in revised form 13 May 2009 published online 15 January 2010.

Abstract

Background

The aim of this study was to identify patient-related and/or disease-related factors that influence outcomes in patients with vascular prosthetic graft infections.

Methods

Through the hospital patient administration system, between January 1997 and December 2007, a total of 44 patients were diagnosed with central prosthetic graft infections. Univariate and multivariate analyses were performed to define factors predictive of mortality.

Results

Thirty-three men and 11 women (mean age, 71 years) were included. There was considerable comorbidity. Coagulase-negative Staphylococcus and S aureus were isolated in almost 50% of the patients. The mean follow-up duration was 5 years, during which 20 patients (46%) died. The main causes of death were related to vascular disease. Conservative treatment with antibiotics was the only variable with significant predictive value on multivariate analysis (hazard ratio, 3.62; 95% confidence interval, 1.17–11.24; P = .02).

Conclusions

Conservative treatment of prosthetic graft infections was associated with high mortality; therefore, it should be limited to a specific group. Patients who are not capable of undergoing open repair may benefit from conservative management. Otherwise, aggressive open treatment seems indicated.

Keywords: Vascular prosthetic graft, Infection, Central, Predictor, Mortality, Positron emission tomography, Autologous vein reconstruction