Aorto-femoral graft infections: a clinical and microbiological analysis.

A 5-year experience of 19 aortic graft infections is reviewed. Of these, 13 (68%) had a late onset (more than 4 months after graft implantation) and usually presented with anastomotic pseudo-aneurysm or thrombosis. The remaining six infections (32%) had an early onset and presented more often with surgical wound infection. Aorto-enteric fistulae and inguinal sinus tracts were observed in both early and late onset infections. Coagulase-negative staphylococci (all slime negative, oxacillin susceptible strains) were the prevalent pathogens in both groups of infections and were isolated in six (32%) patients. Next most commonly seen were Pseudomonas aeruginosa in four (21%) patients, Enterococcus spp. in three (16%) patients, Staphylococcus aureus in three (16%) patients, other bacteria in six (32%) patients. No organisms were isolated in three (16%) patients. Mortality and major amputation rates were 47.3% and 31.6%, respectively. The therapeutic procedures included total graft removal (15 patients), partial graft excision (two patients), partial graft excision followed by total graft removal (one patient) and local treatment without graft removal (one patient). Six patients recovered, including two who underwent total graft removal associated with a non-conventional 'in situ' graft replacement and one patient treated conservatively with local treatment and antibiotics. The three patients undergoing partial graft excision showed signs of active infection of the residual graft.