Vascular graft infection: Difference between revisions

From IDWiki
(Created page with " ==Further Reading== * Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. ''Circulation''....")
 
No edit summary
Line 1: Line 1:
  +
== Background ==
  +
  +
=== Microbiology ===
  +
  +
* [[Staphylococcus aureus]] (30-60%)
  +
* [[Coagulase-negative staphylococci]] (10-30%)
  +
* [[Gram-negative bacilli]] (10-30%), including [[Escherichia coli]], [[Pseudomonas aeruginosa]], [[Klebsiella pneumoniae]]
  +
* [[Viridans group streptococci]] and [[enterococci]] (5%)
  +
* Others: [[Candida species]], polymicrobial infections
  +
* Culture-negative (5-30%)
  +
  +
=== Etiologies ===
  +
  +
* Intraoperative contamination (most common)
  +
* Contiguous spread from superficial infection or intraabdominal infection
  +
* Direct inoculation during subsequent procedure
  +
* Hematogenous spread, less common after the early postoperative period (first 2 months) due to endothelialization
  +
  +
== Clinical Manfestations ==
  +
  +
* Varies by site of graft and infection
  +
* Can be early-onset (first 2 months) or late-onset (after 2 months)
  +
* Late-onset infections tend to be indolent without sepsis
  +
  +
=== Samson Classification ===
  +
  +
* Classification of peripheral arterial prosthetic graft infections [[CiteRef::samson1988a]]
  +
* Minor infections
  +
** '''Group I:''' infection no deeper than the dermis
  +
** '''Group II:''' infection of subcutaneous tissue without visible involvement of graft
  +
* '''Group III:''' infections involving graft but not anastomosis
  +
* '''Group IV:''' infections involving exposed anastomosis without bacteremia or anastomotic bleeding
  +
* '''Group V:''' infections involving graft-to-artery anastomosis with bacteremia or anastomotic bleeding
  +
  +
== Diagnosis ==
  +
  +
* Diagnosis is made clinically
  +
* Ultrasound is usually the initial imaging procedure, followed by CTA or MRI if US is equivocal
  +
* CT- or US-guided aspiration can be helpful for a microbiologic diagnosis
  +
  +
== Management ==
  +
  +
* Local infection without graft involvement: antibiotics with or without incision and drainage (groups I & II)
  +
** Duration 2 to 4 weeks
  +
* Infection involving graft but without bacteremia or anastomotic bleeding (groups III & IV)
  +
** Incision and drainage
  +
** Preservation of graft, or reconstruction with allograft, autograft, or prosthetic material
  +
** 4 to 6 weeks of IV followed by 3 to 6 months of oral
  +
* Infection with bacteremia or anastomotic bleeding (group V)
  +
** Extra-anatomic revascularization followed by graft excision
  +
** 4 to 6 weeks IV followed by 6 months oral
   
 
==Further Reading==
  
==Further Reading==
  +
−
* Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. ''Circulation''. 2016;134:e412-e460. doi: [https://doi.org/10.1161/CIR.0000000000000457 10.1161/CIR.0000000000000457]
 +
*Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. ''Circulation''. 2016;134:e412-e460. doi: [https://doi.org/10.1161/CIR.0000000000000457 10.1161/CIR.0000000000000457]
   
 
[[Category:Endovascular infections]]
  
[[Category:Endovascular infections]]

Revision as of 15:28, 7 March 2021

Background

Microbiology

Etiologies

  • Intraoperative contamination (most common)
  • Contiguous spread from superficial infection or intraabdominal infection
  • Direct inoculation during subsequent procedure
  • Hematogenous spread, less common after the early postoperative period (first 2 months) due to endothelialization

Clinical Manfestations

  • Varies by site of graft and infection
  • Can be early-onset (first 2 months) or late-onset (after 2 months)
  • Late-onset infections tend to be indolent without sepsis

Samson Classification

  • Classification of peripheral arterial prosthetic graft infections 1
  • Minor infections
    • Group I: infection no deeper than the dermis
    • Group II: infection of subcutaneous tissue without visible involvement of graft
  • Group III: infections involving graft but not anastomosis
  • Group IV: infections involving exposed anastomosis without bacteremia or anastomotic bleeding
  • Group V: infections involving graft-to-artery anastomosis with bacteremia or anastomotic bleeding

Diagnosis

  • Diagnosis is made clinically
  • Ultrasound is usually the initial imaging procedure, followed by CTA or MRI if US is equivocal
  • CT- or US-guided aspiration can be helpful for a microbiologic diagnosis

Management

  • Local infection without graft involvement: antibiotics with or without incision and drainage (groups I & II)
    • Duration 2 to 4 weeks
  • Infection involving graft but without bacteremia or anastomotic bleeding (groups III & IV)
    • Incision and drainage
    • Preservation of graft, or reconstruction with allograft, autograft, or prosthetic material
    • 4 to 6 weeks of IV followed by 3 to 6 months of oral
  • Infection with bacteremia or anastomotic bleeding (group V)
    • Extra-anatomic revascularization followed by graft excision
    • 4 to 6 weeks IV followed by 6 months oral

Further Reading

  • Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation. 2016;134:e412-e460. doi: 10.1161/CIR.0000000000000457

References

  1. ^  Russell H. Samson, Frank J. Veith, Gary S. Janko, Sushil K. Gupta, Larry A. Scher. A modified classification and approach to the management of infections involving peripheral arterial prosthetic grafts. Journal of Vascular Surgery. 1988;8(2):147-153. doi:10.1016/0741-5214(88)90402-8.

Retrieved from "https://idwiki.org/index.php?title=Vascular_graft_infection&oldid=7693"
Powered by MediaWiki
Powered by Semantic MediaWiki