Division of Vascular Surgery, University of Rochester Medical Center, Rochester, New York.
Department of Surgery, University of Rochester Medical Center, Rochester, New York.
J Surg Res. 2024 Nov;303:772-779. doi: 10.1016/j.jss.2024.09.079. Epub 2024 Oct 30.
Inguinal vascular surgical site infections (VSSI) and infected prosthetic grafts remain a critical problem in vascular surgery. Prior clinical reports suggest antibiotic-impregnated beads may be used to attempt salvage of the graft and improve outcomes, especially if explant would result in major amputation or mortality. Described is our institutional experience managing inguinal VSSI using bioabsorbable, antibiotic-impregnated beads compared to inguinal VSSI managed with debridement alone.
Patients with VSSIs after lower-extremity procedures were identified through the institutional database and departmental registries from 2014 to 2023. Cases were excluded if they did not involve an inguinal wound infection or an operation for VSSI management. Outcomes, including amputation-free survival, reinfection, and re-operation for infection were recorded, along with microbial isolates. Basic descriptive statistics, Kaplan-Meier, and Multiple variable Cox proportional hazards analyses were performed.
There were 43 patients identified (23 with intravenous antibiotics and debridement alone, and 20 treated with intravenous antibiotics, debridement, and antibiotic beads). The two groups differed significantly in their Szilagyi classification, with thirteen patients (65%) with class III infections in the antibiotic bead group compared with one (7%) in the debridement alone group. There was no significant difference in amputation-free survival for those cases that received debridement and antibiotic beads versus debridement alone (P = 0.20) or amputation-free survival between Szilagyi classifications (P = 0.47) despite a higher representation of Szilagyi III cases in the antibiotic bead group (P = 0.0001). Patients with graft infections treated with beads experienced similar survival outcomes to patients with subcutaneous infections treated with debridement alone (P = 0.21).
The efficacy of bioabsorbable antibiotic beads in VSSIs remains controversial. While this cohort study demonstrated an increased risk of re-infection, this is confounded by the antibiotic bead group having a higher frequency of graft infections. Antibiotic beads appear to be safe for use in patients with vascular graft infections and may help achieve outcomes comparable to patients without graft involvement. Further studies with larger patient populations and similar infection severity between groups are needed.
腹股沟血管外科部位感染（VSSI）和感染性假体移植物仍然是血管外科的一个关键问题。先前的临床报告表明，抗生素浸渍珠可用于尝试挽救移植物并改善结果，特别是如果切除会导致主要截肢或死亡。本文描述了我们机构使用可吸收抗生素浸渍珠治疗腹股沟 VSSI 的经验，与单独清创治疗腹股沟 VSSI 相比。
通过机构数据库和部门登记册，从 2014 年至 2023 年确定了下肢手术后发生 VSSI 的患者。如果感染不涉及腹股沟伤口感染或 VSSI 管理手术，则排除病例。记录了包括无截肢生存率、再感染和因感染再次手术的结果，以及微生物分离株。进行了基本描述性统计、Kaplan-Meier 和多变量 Cox 比例风险分析。
共确定了 43 例患者（23 例接受静脉内抗生素和单独清创治疗，20 例接受静脉内抗生素、清创和抗生素珠治疗）。两组在 Szilagyi 分类方面存在显著差异，抗生素珠组有 13 例（65%）患者为 III 类感染，而单独清创组仅有 1 例（7%）。接受清创和抗生素珠治疗的病例与单独清创相比，无截肢生存率无显著差异（P=0.20），或 Szilagyi 分类之间的无截肢生存率无显著差异（P=0.47），尽管抗生素珠组 Szilagyi III 病例比例较高（P=0.0001）。接受珠粒治疗的移植物感染者的生存结果与接受单独清创治疗的皮下感染者相似（P=0.21）。
可吸收抗生素珠在 VSSI 中的疗效仍存在争议。虽然本队列研究表明再感染的风险增加，但这与抗生素珠组更频繁的移植物感染有关。抗生素珠似乎对血管移植物感染患者是安全的，并且可能有助于获得与无移植物受累患者相当的结果。需要进行更大患者人群和组间类似感染严重程度的进一步研究。
