Outcomes of Infected Abdominal Aortic Grafts Managed with Antimicrobial Therapy and Graft Retention in an Unselected Cohort

• Published in: European journal of vascular and endovascular surgery 2013-04, Vol.45 (4), p.373-380
• Main Authors: Maze, M.J, Laws, P, Buckenham, T, Pithie, A, Gallagher, K, Metcalf, S, Roake, J, Chambers, S.T
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-infective agents; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Aortic Aneurysm, Abdominal - surgery; Blood vessel prosthesis; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Blood Vessel Prosthesis Implantation - mortality; Device Removal; Drug Administration Schedule; Enterobacteriaceae - isolation & purification; Female; Graft preservation; Humans; Kaplan-Meier Estimate; Male; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; New Zealand; Prosthesis related infections; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - mortality; Recurrence; Reoperation; Retrospective Studies; Streptococcus - isolation & purification; Surgery; Time Factors; Treatment Outcome
• ISSN: 1078-5884; 1532-2165
• DOI: 10.1016/j.ejvs.2013.01.019

Objective To document the treatment of all patients with infected aortic grafts at Christchurch Hospital between 1999 and 2010, focussing on the mortality and morbidity of those treated without graft explantation. Methods Cases of infected aortic grafts were reviewed. Cases required a compatible clinical syndrome, CT imaging and tissue/blood culture results. Results Eighteen patients were identified. Organisms isolated at diagnosis from blood or graft site were Staphylococcus aureus 6 (MRSA 1), beta haemolytic streptococci 2, enteric organisms 9. There was no isolate from 2. One case had graft explantation and brief antimicrobial therapy. Seventeen patients had the graft retained. Of these, 14 received intravenous antimicrobial therapy for 6 weeks and 14 lifelong oral therapy. None died during their initial admission or within 30 days. During a mean follow-up of 57 months, 10 (59%) relapsed (median time 31 months, range 0–98), 4 (24%) underwent graft explantation and 10 (59%) died (median 40 months, range 1–198). Four of 10 who relapsed had organisms isolated (all enteric). Conclusion Patients treated with lifelong antimicrobial therapy and graft retention survived a median of 41 months, with low early mortality although over half relapsed. Empiric therapy should cover skin organisms and enteric organisms, even for those outside the post-operative period.