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In situ replacement of vascular prostheses infected by bacterial biofilms. J Vasc Surg 1991 May;13(5):575-83

Date

05/01/1991

Pubmed ID

2027196

DOI

10.1016/0741-5214(91)90339-V

Scopus ID

2-s2.0-0025868413   123 Citations

Abstract

Late prosthetic graft infections are commonly the result of coagulase-negative staphylococci that survive within a biofilm on prosthetic surfaces and provoke perigraft inflammation. The indolent nature and microbiologic characteristics of bacterial biofilm infections coupled with the morbidity of graft excision and extraanatomic bypass grafting prompted us to use in situ graft replacement in 15 patients admitted to the hospital with 17 infected graft segments at a mean (+/- SEM) time interval of 70 +/- 16 months after graft implantation (n = 6) or revision (n = 9). Since 1986, 17 grafts (14 aortofemoral, 2 axillofemoral, and 1 femoropopliteal) infected by bacterial biofilms have been treated. Signs on admission included femoral pseudoaneurysm (n = 7), perigraft abscess (n = 6), or graft-cutaneous sinus tract (n = 4). No patient exhibited septicemia. At operation graft incorporation was absent and Gram's stain of perigraft exudate showed polymorphonuclear leukocytes but no bacteria. Culture of explanted graft material isolated coagulase-negative staphylococci (n = 12), Staphylococcus aureus (n = 1), and no growth (n = 2). All patients were successfully treated by a regimen that included parenteral antibiotics, removal of involved graft material, excision of inflamed perigraft tissue, and in situ replacement with an expanded polytetrafluoroethylene prosthesis. No deaths, graft thromboses, or deep wound infections occurred after operation. Recurrent graft infection did not develop during a follow-up interval that ranged from 5 to 50 months (mean, 21 months). Diagnosis of vascular prosthesis infection caused by bacterial biofilms can be based on signs at admission and operative findings. Complications of this perigraft infection can be eradicated by antibiotic administration, local debridement, and in situ graft replacement.

Author List

Bandyk DF, Bergamini TM, Kinney EV, Seabrook GR, Towne JB

Author

Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Aorta
Aortography
Blood Vessel Prosthesis
Female
Femoral Artery
Humans
Male
Methods
Middle Aged
Popliteal Artery
Prognosis
Reoperation
Staphylococcal Infections
Staphylococcus aureus
Staphylococcus epidermidis
Tomography, X-Ray Computed
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc