Chapter 7 : Arterial Prosthetic Infections

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This chapter focuses on arterial prosthetic infections. In two reviews of the literature done in 1983 and 1992, the overall incidence of graft infection was estimated to be about 2%. When looking at the distribution of microorganisms according to the site of graft implantation three points deserve mention. First, intestinal microorganisms appear responsible for most aortoiliac infections when no groin incision has been done. Second, is now the leading pathogen after aortofemoral reconstruction. Third, remains the principal pathogen in most series after infrainguinal reconstructions. The majority of patients with an early infection of a superficial prosthesis will present overt signs of infections, such as an inflammatory perigraft mass, an abscess, a draining sinus tract, a palpable anastomotic pseudoaneurysm, or an exposed graft. The occurrence of ‘’true’’ failures of correctly administered prophylaxis reported with cephalosporins, that is, the occurrence of an infection due to microorganisms sensitive to the administered antibiotic, and the increased role of gram-negative bacteria leave room for debate regarding the choice of prophylactic antibiotics. However, this discussion is difficult because many questions remain unanswered about the physiopathology of vascular graft infection and the mechanisms of the prophylactic activity of antibiotics. The authors demonstrated that rifampin-bonded gelatin-sealed grafts were resistant to infection when used for in situ replacement of a graft by . In this study, conducted in 2,610 patients in 90 centers, the incidence of wound infection was significantly reduced in patients receiving a rifampin-bonded graft in association with perioperative systemic antimicrobial prophylaxis.

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7

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Figure 1

Incidence of microorganisms according to the site of graft implantation. Percentages are estimated from references , and (left), , and (center), and , and (right). ,; Neg. cult., negative culture; Miscel., miscellaneous; Enterob., ; ,

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7
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Table 1

Classification of wound and graft infections

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7
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Table 2

Incidence of prosthetic arterial graft infection

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7
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Table 3

Factors predisposing to graft infection

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7
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Table 4

Proposals for perioperative antibiotic prophylaxis in vascular surgery

Citation: Goëau-Brissonnière O, Coggia M. 2000. Arterial Prosthetic Infections, p 127-144. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch7

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