Braams Lisanne, Vlaspolder Gro, Boiten Kathleen, Salomon Elisa, Winter Rik, Saleem Ben, Wouthuyzen-Bakker Marjan, van Oosten Marleen
Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Microbiol Spectr. 2023 Feb 27;11(2):e0372222. doi: 10.1128/spectrum.03722-22.
Vascular graft and endograft infection (VGEI) is a severe complication associated with high mortality and is often challenging to diagnose. For the definitive microbiological diagnosis, sonication of vascular grafts may increase the microbiological yield of these biofilm-associated infections. The objective of this study was to determine whether sonication of explanted vascular grafts and endografts results in a higher diagnostic accuracy than conventional culture methods and aids in clinical decision-making. A prospective diagnostic study was performed comparing conventional culture with sonication culture of explanted vascular grafts in patients treated for VGEI. Explanted (endo)grafts were cut in halves and were either subjected to sonication or conventional culture. Criteria based on the Management of Aortic Graft Infection Collaboration (MAGIC) case definition of VGEI were used for definitive diagnosis. The relevance of sonication cultures was assessed by expert opinion to determine the clinical impact on decision-making. Fifty-seven vascular (endo)graft samples from 36 patients (four reoperations; 40 episodes) treated for VGEI were included; 32 episodes were diagnosed with VGEI. Both methods showed a positive culture in 81% of the cases. However, sonication culture detected clinically relevant microorganisms that went unnoticed by conventional culturing in 9 out of 57 samples (16%, 8 episodes) and provided additional relevant information regarding growth densities in another 11 samples (19%, 10 episodes). Sonication of explanted vascular grafts and endografts improves the microbiological yield and aids in the clinical decision-making for patients with a suspected VGEI compared to conventional culture alone. Sonication culture of explanted vascular grafts was shown to be a noninferior method compared to conventional culturing in diagnosing vascular graft and endograft infection (VGEI). Moreover, sonication culture has probable additional value in microbiological characterization of VGEI by giving more detailed information on growth densities, especially when the conventional culture shows intermediate growth. In this prospective design, for the first time, a direct comparison is made between sonication culturing and conventional culturing in VGEI, while taking clinical interpretation into account. Therefore, this study is another step toward a more accurate microbiological diagnosis of VGEI, influencing clinical decision-making.
血管移植物和腔内移植物感染（VGEI）是一种严重并发症，死亡率高，诊断往往具有挑战性。对于明确的微生物学诊断，对血管移植物进行超声处理可能会提高这些生物膜相关感染的微生物学检出率。本研究的目的是确定对取出的血管移植物和腔内移植物进行超声处理是否比传统培养方法具有更高的诊断准确性，并有助于临床决策。我们进行了一项前瞻性诊断研究，比较了接受VGEI治疗患者的取出血管移植物的传统培养和超声培养。将取出的（腔内）移植物切成两半，分别进行超声处理或传统培养。基于主动脉移植物感染管理协作组（MAGIC）VGEI病例定义的标准用于明确诊断。通过专家意见评估超声培养的相关性，以确定其对决策的临床影响。纳入了36例接受VGEI治疗患者的57个血管（腔内）移植物样本（4例再次手术；40次发作）；32次发作被诊断为VGEI。两种方法在81%的病例中培养结果呈阳性。然而，超声培养在57个样本中的9个（16%，8次发作）中检测到了传统培养未发现的临床相关微生物，并在另外11个样本（19%，10次发作）中提供了关于生长密度的额外相关信息。与单独的传统培养相比，对取出的血管移植物和腔内移植物进行超声处理可提高微生物学检出率，并有助于对疑似VGEI患者进行临床决策。在诊断血管移植物和腔内移植物感染（VGEI）方面，取出血管移植物的超声培养被证明是一种与传统培养非劣效的方法。此外，超声培养通过提供关于生长密度的更详细信息，在VGEI的微生物学特征分析中可能具有额外价值，特别是当传统培养显示中等生长时。在这个前瞻性设计中，首次在VGEI中对超声培养和传统培养进行了直接比较，同时考虑了临床解读。因此，本研究朝着更准确的VGEI微生物学诊断迈出了又一步，影响了临床决策。
