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动静脉移植物感染的管理

Management of Arteriovenous Graft Infection.

作者信息

Hisata Yoichi, Inoue Taku, Tasaki Yuichi, Odate Tomohiro, Yamada Takafumi

机构信息

Division of Cardiovascular Surgery, Oita Prefectural Hospital, Oita, Oita, Japan.

Division of Cardiovascular Surgery, Sasebo Chuo Hospital, Sasebo, Nagasaki, Japan.

出版信息

Ann Vasc Dis. 2022 Dec 25;15(4):282-288. doi: 10.3400/avd.oa.22-00058.

Abstract

: Arteriovenous graft (AVG) infection influences the survival and quality of life of patients, causing life-threatening sepsis reducing dialysis access. This study aimed to evaluate an appropriate treatment strategy for AVG infection. : We analyzed 61 cases involving AVG infections identified at a single center. The cases were divided into two groups based on the type of AVG and surgical methods, namely, currently used AVG (cAVG) (n=29) or abandoned AVG (aAVG) (n=32) and total graft excision (TGE) (n=10) or partial graft excision (PGE) (n=46). : There was a significant difference in lower procedure frequency (p<0.001) and longer procedure time (p=0.014) in the cAVG group. A significant difference in lower reinfection rate (p=0.009) was found in the TGE group. Multivariable analysis confirmed that aAVG significantly independently affected the reinfection rate (hazard ratio, 2.208; 95% confidence interval, 1.069-4.561; p=0.032). was the most frequent cause of AVG infection (61.5%); 77.5% of were methicillin-resistant . : We found a higher risk of reinfection after PGE than TGE, and aAVG infection was associated with approximately two times higher likelihood of reinfection. These findings suggest that TGE should be considered for patients with AVG infections, particularly aAVG infections.

摘要

动静脉移植物(AVG)感染会影响患者的生存和生活质量,引发危及生命的败血症,减少透析通路。本研究旨在评估AVG感染的合适治疗策略。我们分析了在单一中心确诊的61例AVG感染病例。根据AVG类型和手术方法将病例分为两组,即目前使用的AVG(cAVG)(n = 29)或废弃的AVG(aAVG)(n = 32)以及全移植物切除术(TGE)(n = 10)或部分移植物切除术(PGE)(n = 46)。cAVG组在较低的操作频率(p < 0.001)和较长的操作时间(p = 0.014)方面存在显著差异。TGE组在较低的再感染率(p = 0.009)方面存在显著差异。多变量分析证实,aAVG显著独立影响再感染率(风险比,2.208;95%置信区间,1.069 - 4.561;p = 0.032)。是AVG感染最常见的原因(61.5%);77.5%的是耐甲氧西林的。我们发现PGE后再感染的风险高于TGE,且aAVG感染与再感染可能性高约两倍相关。这些发现表明,对于AVG感染患者,尤其是aAVG感染患者,应考虑TGE。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e00d/9816041/7f6b4bee8b70/avd-15-4-oa.22-00058-figure01.jpg

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