Section of Vascular & Endovascular Surgery, University of California, San Diego School of Medicine, San Diego, CA, USA.
Semin Vasc Surg. 2011 Dec;24(4):191-8. doi: 10.1053/j.semvascsurg.2011.10.013.
Surgical site infection (SSI) after aortic intervention, an uncommon but serious vascular condition, requires patient-specific antibiotic therapy. Effective treatment and prevention requires the vascular surgeon to be cognizant of changing SSI microbiology, advances in antibiotic delivery, and patient characteristics. The majority of aortic graft infections are caused by Gram-positive bacteria, with methicillin-resistant Staphylococcus aureus now the prevalent pathogen. Nasal carriage of methicillin-sensitive or methicillin-resistant S aureus strains, diabetes mellitus, recent hospitalization, a failed arterial reconstruction, and the presence of a groin incision are important SSI risk factors. Overall, the aortic SSI rate is higher than predicted by the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance risk category system; ranging from 5% after open or endovascular aortic interventions to as high as 10% to 15% after aortofemoral bypass or uni-aortoiliac grafting with femorofemoral bypass. Perioperative measures to reduce S aureus nares and skin colonization, administration of antibiotic prophylaxis, meticulous wound closure/care, and therapy directed to optimize patient host defense regulation mechanisms (eg, temperature, oxygenation, blood sugar) can minimize SSI occurrence. Antibiotic therapy for aortic graft infection should utilize bactericidal drugs that penetrate bacteria biofilms and can be delivered to the surgical site both parenterally and locally in the form of antibiotic-impregnated beads or prosthetic grafts.
主动脉介入术后的手术部位感染（SSI）是一种不常见但严重的血管疾病，需要针对患者的抗生素治疗。有效的治疗和预防需要血管外科医生了解不断变化的 SSI 微生物学、抗生素输送的进步以及患者特征。大多数主动脉移植物感染是由革兰阳性菌引起的，耐甲氧西林金黄色葡萄球菌现在是主要病原体。鼻腔携带甲氧西林敏感或耐甲氧西林金黄色葡萄球菌株、糖尿病、近期住院、动脉重建失败以及腹股沟切口的存在是重要的 SSI 危险因素。总体而言，主动脉 SSI 发生率高于疾病预防控制中心（CDC）全国医院感染监测风险分类系统的预测；从开放或血管内主动脉介入术后的 5%到腹主动脉-股动脉旁路或单侧-髂动脉移植伴股-股旁路术后的 10%至 15%不等。减少金黄色葡萄球菌鼻腔和皮肤定植的围手术期措施、给予抗生素预防、仔细的伤口闭合/护理以及针对优化患者宿主防御调节机制（如体温、氧合、血糖）的治疗可以最大限度地减少 SSI 的发生。主动脉移植物感染的抗生素治疗应使用能够穿透细菌生物膜的杀菌药物，并以抗生素浸渍珠或假体移植物的形式经静脉内和局部给药到手术部位。
