Vascular graft infection: Difference between revisions
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== Background == |
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=== Microbiology === |
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* [[Staphylococcus aureus]] (30-60%) |
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* [[Coagulase-negative staphylococci]] (10-30%) |
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* [[Gram-negative bacilli]] (10-30%), including [[Escherichia coli]], [[Pseudomonas aeruginosa]], [[Klebsiella pneumoniae]] |
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* [[Viridans group streptococci]] and [[enterococci]] (5%) |
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* Others: [[Candida species]], polymicrobial infections |
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* Culture-negative (5-30%) |
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=== Etiologies === |
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* Intraoperative contamination (most common) |
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* Contiguous spread from superficial infection or intraabdominal infection |
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* Direct inoculation during subsequent procedure |
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* Hematogenous spread, less common after the early postoperative period (first 2 months) due to endothelialization |
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== Clinical Manfestations == |
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* Varies by site of graft and infection |
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* Can be early-onset (first 2 months) or late-onset (after 2 months) |
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* Late-onset infections tend to be indolent without sepsis |
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=== Samson Classification === |
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* Classification of peripheral arterial prosthetic graft infections [[CiteRef::samson1988a]] |
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* Minor infections |
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** '''Group I:''' infection no deeper than the dermis |
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** '''Group II:''' infection of subcutaneous tissue without visible involvement of graft |
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* '''Group III:''' infections involving graft but not anastomosis |
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* '''Group IV:''' infections involving exposed anastomosis without bacteremia or anastomotic bleeding |
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* '''Group V:''' infections involving graft-to-artery anastomosis with bacteremia or anastomotic bleeding |
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== Diagnosis == |
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* Diagnosis is made clinically |
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* Ultrasound is usually the initial imaging procedure, followed by CTA or MRI if US is equivocal |
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* CT- or US-guided aspiration can be helpful for a microbiologic diagnosis |
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== Management == |
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* Local infection without graft involvement: antibiotics with or without incision and drainage (groups I & II) |
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** Duration 2 to 4 weeks |
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* Infection involving graft but without bacteremia or anastomotic bleeding (groups III & IV) |
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** Incision and drainage |
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** Preservation of graft, or reconstruction with allograft, autograft, or prosthetic material |
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** 4 to 6 weeks of IV followed by 3 to 6 months of oral |
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* Infection with bacteremia or anastomotic bleeding (group V) |
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** Extra-anatomic revascularization followed by graft excision |
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** 4 to 6 weeks IV followed by 6 months oral |
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==Further Reading== |
==Further Reading== |
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* |
*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] |
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[[Category:Endovascular infections]] |
[[Category:Endovascular infections]] |
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Revision as of 19:28, 7 March 2021
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 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
- ^ 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.
