Service Universitaire de Maladies Infectieuses, Centre Hospitalier Dron, Rue du Président-Coty, 59208 Tourcoing, France.
Med Mal Infect. 2012 Mar;42(3):102-9. doi: 10.1016/j.medmal.2012.01.003. Epub 2012 Feb 16.
Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections.
人造血管移植物感染是一种罕见但非常严重的并发症，死亡率很高。其最佳治疗方法需要在参考中心进行适当的手术治疗，并结合适当的抗菌治疗。作者希望重点关注人造血管移植物感染的治疗，并确定血管移植物感染的临床、微生物学、生物学和放射学标准。虽然这些都是小系列研究，但补充性检查包括 CT 扫描，这是急性感染诊断的金标准，其敏感性和特异性均达到 100%，但在慢性感染时降至 55%。最近，PET 扫描在慢性感染中的研究也取得了良好的效果（敏感性 98%，特异性 75.6%，阳性预测值 88.5%，阴性预测值 84.4%）。与骨科和血管感染一样，人造血管移植物感染的治疗需要更换血管移植物。微生物学数据与血管感染的部位或类型之间没有相关性。因此，术后静脉内抗菌治疗应该是杀菌性的，具有广谱性。在获得术中微生物学结果后，必须包括至少一种抗黏附药物，如葡萄球菌感染中的利福平。
