Service de Réanimation et Maladies Infectieuses, CHRU, Lille, France.
Curr Opin Infect Dis. 2012 Apr;25(2):154-8. doi: 10.1097/QCO.0b013e3283501853.
This review provides a focus on infections of prosthetic vascular grafts used to treat peripheral arterial diseases.
The incidence of infections varies between 1 and 6%. Risk factors of infection are not well identified. Main causative pathogens are Gram-negative bacilli, Staphylococcus aureus, and coagulase-negative staphylococci, without clear differences according to location of graft and time of onset of infection. There is no consensual diagnostic criterion. The basic principles for management of graft infections have been known for many years. A surgical approach combining graft excision, complete debridement, and maintaining distal vascular flow is required. Antimicrobial therapy is always instituted to reduce sepsis and prevent secondary graft infection, but there are no evidence-based data to recommend any regimen. However, antibiotics should have bactericidal activity whatever the bacteria growth phase, reduce the microbial burden, penetrate within the biofilm, and prevent further biofilm formation. Mortality and morbidity from these infections remain significant.
A multidisciplinary approach with a limited number of reference centres, recruiting sufficient numbers of patients to perform controlled trials, and to provide expert recommendations, could be the best way to answer unresolved questions and improve the prognosis.
本综述重点关注用于治疗外周动脉疾病的人工血管移植物感染。
感染的发生率在 1%至 6%之间。感染的危险因素尚未明确。主要病原体为革兰氏阴性杆菌、金黄色葡萄球菌和凝固酶阴性葡萄球菌，根据移植物位置和感染发生时间的不同，没有明显差异。目前还没有共识的诊断标准。多年来，人们已经了解了管理移植物感染的基本原则。需要采用手术方法切除移植物，彻底清创，并保持远端血管通畅。始终进行抗菌治疗以减少败血症并预防继发性移植物感染，但没有基于证据的数据来推荐任何方案。然而，抗生素无论在细菌生长的哪个阶段都应该具有杀菌活性，减少微生物负担，渗透到生物膜内，并防止进一步形成生物膜。这些感染的死亡率和发病率仍然很高。
多学科方法，有数量有限的参考中心，招募足够数量的患者进行对照试验，并提供专家建议，可能是回答未解决问题和改善预后的最佳方法。
