Legout Laurence, Delia Piervito, Sarraz-Bournet Béatrice, Rouyer Cécile, Massongo Massongo, Valette Michel, Leroy Olivier, Haulon Stephan, Senneville Eric
Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France.
BMC Infect Dis. 2014 Apr 28;14:228. doi: 10.1186/1471-2334-14-228.
There exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).
All data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.
84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].
Results of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.
关于人工血管移植物感染（PVGI）的管理存在相当大的争议，尤其是在抗菌治疗方面。本报告研究了葡萄球菌性PVGI患者队列中与治疗失败相关的因素，以及利福平（RIF）的影响。
回顾了2006年至2010年间PVGI患者的所有数据。治愈定义为在至少一年的整个治疗后随访期间无感染证据。失败定义为任何其他结果。
84例患者（72例男性/12例女性，中位年龄64.5±11岁）患有糖尿病（n = 25）、肥胖症（n = 48）、冠状动脉疾病（n = 48）、肾衰竭（n = 24）或慢性阻塞性肺病（n = 22），接受了PVGI治疗（中位随访时间为470±469天）。PVGI主要为腔内感染（n = 47）。鉴定出金黄色葡萄球菌（n = 65；包括17株耐甲氧西林金黄色葡萄球菌）和凝固酶阴性葡萄球菌（n = 22）。71例患者接受了手术治疗。在单因素分析中，与失败相关的显著危险因素包括肾衰竭（p = 0.04）、主动脉瘤（p = 0.03）、发热（p = 0.009）、动脉瘤破裂（p = 0.02）、围手术期感染性休克（p = 0.005）和含RIF的抗生素治疗（p = 0.03）。在多因素分析中，有2个变量与失败独立相关：感染性休克[比值比4.98：95%置信区间1.45 - 16.99；p = 0.01]和含利福平的抗生素[比值比：0.32：95%置信区间0.10 - 0.96；p = 0.04]。
本研究结果表明，发热、感染性休克以及未使用含RIF的抗生素治疗与不良预后相关。
