Igari Kimihiro, Kudo Toshifumi, Toyofuku Takahiro, Jibiki Masatoshi, Sugano Norihide, Inoue Yoshinori
Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan,
Surg Today. 2014 Mar;44(3):466-71. doi: 10.1007/s00595-013-0571-z. Epub 2013 Apr 5.
The aim of this study was to investigate the outcomes correlated with our treatment strategy for prosthetic graft infection.
Seventeen patients were treated for prosthetic graft infections between 1997 and 2009. Initially, total graft excision was applied in five cases, partial graft excision was applied in six cases and graft preservation with drainage and irrigation was applied in six cases. Among the graft-preserved cases, four patients were infected with methicillin-resistant Staphylococcus aureus (MRSA) and treated with gentian violet (GV).
The overall survival rate was 88% at 30 days and 82% at 1 year in this series. Of the excised cases, nine patients survived; however, two patients died. Among the cases in which MRSA-infected grafts were preserved, three patients survived; however, one patient died under a septicemic state. Infected graft preservation was applied at a high rate of 36%, and the mortality rate remained at 16%, without any signs of graft reinfection.
In the treatment of infected grafts, the patient's condition should be considered in order to select the appropriate treatment in each case. Graft preservation should be considered as an alternative treatment option, especially in high-risk patients, and GV can be effective for conservative treatment of prosthetic graft infections, including MRSA infections.
本研究旨在调查与我们的人工血管移植物感染治疗策略相关的结果。
1997年至2009年间，对17例人工血管移植物感染患者进行了治疗。最初，5例患者进行了移植物全切，6例患者进行了部分移植物切除，6例患者采用了保留移植物并进行引流和冲洗的方法。在保留移植物的病例中，4例患者感染耐甲氧西林金黄色葡萄球菌（MRSA），并接受了龙胆紫（GV）治疗。
该系列患者30天总生存率为88%，1年总生存率为82%。在切除移植物的病例中，9例患者存活；然而，2例患者死亡。在保留MRSA感染移植物的病例中，3例患者存活；然而，1例患者在败血症状态下死亡。感染移植物保留的应用率高达36%，死亡率保持在16%，且没有任何移植物再次感染的迹象。
在治疗感染的移植物时，应考虑患者的病情，以便为每个病例选择合适的治疗方法。应将保留移植物视为一种替代治疗选择，尤其是在高危患者中，并且GV可有效用于人工血管移植物感染的保守治疗，包括MRSA感染。
