Risk Factors Associated With Vascular Graft Infection Identified

antibiotics, stewardship
antibiotics, stewardship
Perioperative prophylaxis and thorough postsurgical management may be key components in helping to prevent vascular graft infections.

Perioperative prophylaxis and thorough postsurgical management may be key components in preventing vascular graft infections, according to study findings published in Clinical Infectious Diseases.

Vascular grafts are susceptible to infection, but several patient-related and surgery-related risk factors can increase the risk for vascular surgical site infections, including bacteremia that occurs during hospitalization for vascular repair and postoperative wound infections or other postsurgical complications. Most research on vascular graft infection risk factors has been retrospective. Therefore, this study sought to prospectively identify potentially modifiable risk factors to improve prevention strategies.

The study cohort included 438 participants from the prospective Vascular Graft Cohort Study (VASGRA) who underwent surgery between 2013 and 2017. The observation time was calculated from surgery until either confirmed vascular graft infection or last follow-up. Of this group, vascular graft infection developed in 8.9% (n=39). Risk factors observed for development of vascular graft infection included incisional surgical site infections (adjusted hazard ratio [aHR] 10.09; 95% CI, 2.88-35.34), hemorrhage (aHR 4.92; 95% CI, 1.28-18.94), renal insufficiency (aHR 4.85, 95% CI, 1.20-19.61), and procedure time per 1-hour increase (aHR 1.22; 95% CI, 1.08-1.39). In addition, the researchers also differentiated between patients who received perioperative prophylaxis only (94.3%, n=413) and those who had an established antibiotic regimen for treatment of another infection at the time of the index surgery (5.3%, n=23). In the perioperative prophylaxis group, vascular graft infection developed in 7.7% (32/413) vs 43.5% (10/23) of those with an established antibiotic treatment.

“Hazard ratios for open surgery, total procedure time, certain graft materials, inadequate perioperative antimicrobial prophylaxis, postsurgical wound infections, and other infectious complications were associated with [vascular graft infections],” wrote the researchers. “After multivariable adjustment for age, gender, and body mass index, associations with [vascular graft infections] remained robust except for open surgery.”

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Anagnostopoulos A, Ledergerber B, Kuster SP, et al. Inadequate perioperative prophylaxis and postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections – prospective results from the VASGRA Cohort Study [published online November 5, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy956