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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2005 December;12(4):117-27
Prophylaxis of vascular graft infection: long-term results of a prospective study
Pedrini L., Pisano E., Sensi L., Ballestrazzi M. S., Magnoni F., Magagnoli A., Cirelli M. R.
Vascular Surgery Unit Ospedale Maggiore, Bologna, Italy
Aim. Graft infection is a severe complication of vascular surgery and carries a high incidence of amputation and death. Despite the widespread use of antibiotic prophylaxis, the incidence of infection remains a problem, with rates of 0.5% reported in abdominal reconstruction, 1-2% in aortofemoral revascularization and 5-8% after axillofemoral bypass operations. Guidelines for the prevention of surgical site infections (SSI) list a host of recommendations, among which antibiotic prophylaxis is just one of many measures suggested to reduce this complication. The aim of this study was to evaluate the results of a protocol designed to prevent graft infection.
Methods. Between 1997 and 2003, 3 153 surgical patients received antimicrobial prophylaxis according to 6 different protocols and were then followed-up prospectively. The protocols were designed taking into account the low prophylactic activity of second generation cephalosporins, the increased resistance of common pathogens found in vascular grafts to these antibiotics, the scarce results of some single-dose regimens with vancomycin and of multiple-dose administration of cephalosporins, and the high incidence of coagulase-negative staphylococci in late infections.
Results. At 2.4 years mean follow-up, the incidence of graft infection was 0.66% (6 early and 7 late); 1 patient presented infection in 2 sites and 1 patient had 2 recurrent infections. The mean time between graft insertion and infection was 6.6 months. Gangrene, emergency and reoperation were the most common risk factors even in our sample. Prolonged operating times and redo operations without repeated administration of antibiotic therapy were probably the most important cofactors. The most frequent pathogen was Staphylococcus aureus (4 cases, 2 methicillin-resistant Staphylococcus aureus, MRSA); in 3 cases the culture tested negative.
Conclusion. Our results suggest that multi-dose treatment with the combination of clindamycin and gentamycin and the correct use of preoperative prophylaxis techniques lower the incidence of vascular graft infections more effectively than using standard guidelines recommendations; however, new prospective randomized studies are needed.