Graft infection in vascular surgery

Napredak medicine i tehnologije, porast životnog standarda i suvremeni sjedilački način života doveli su do starenja populacije i povećanja broja bolesnika s indikacijom za angiokirurški zahvat. Infekcije su jedna su od najtežih komplikacija tih zahvata, jer su povezane s teškim, često i po život opasnim posljedicama. Cilj ovog istraživanja bio je otkriti čimbenike koji utječu na pojavu MRSA infekcije, kao i na pojavu najtežih komplikacija infekcija graftova (eng. graft – kalem, presadak, transplantat) - gubitka ekstremiteta i smrti. Ovo retrospektivno istraživanje uključilo je bolesnike koji su operirani zbog infekcije nakon angiokirurške rekonstrukcije, u Zavodu za vaskularnu kirurgiju Klinike za kirurgiju Kliničkog bolničkog centra Zagreb, u razdoblju od 1996. do 2012. godine. Istražene su značajke bolesnika, rekonstrukcijskog zahvata i boravka u bolnici, te mikrobiološki pokazatelji infekcije, kao i način i ishod liječenja infekcije. Infekcija je evidentirana kod 118 bolesnika nakon 3518 angiokirurških revaskularizacija (3,35%). MRSA infekciju je razvilo 49 bolesnika s infekcijom (41,53%). Amputacija je učinjena u 12 bolesnika s infekcijom (10,17%), a smrt je nastupila u njih 10 (8,48%). Upotreba infraingvinalne sintetske premosnice pokazala se kao čimbenik rizika za pojavu MRSA infekcije, amputaciju i smrtni ishod. Kao dodatni čimbenici rizika pokazali su se dob bolesnika, dijabetes, hipertenzija, pušenje, trajanje hospitalizacije i težina infekcije. Rezultati ovog istraživanja potvrdili su rezultate drugih svjetskih studija i naglasili važnost učinkovitog liječenja kroničnih bolesti, prestanka pušenja, kraćeg predoperativnog boravka u bolnici i agresivnog liječenja već razvijene infekcije. Također, zamjena sintetskih graftova autolognim i heterolognim graftovima, te istraživanje novih mogućnosti liječenja vaskularnih bolesti, mogli bi u budućnosti dovesti do smanjenja incidencije infekcija nakon angiokirurških zahvata, te amputacija i smrtnosti.Development of medicine and related technologies, increase in living standards and modern sedentary lifestyle have led to population aging and an increase in the number of patients with an indication for vascular reconstruction. Infection is one of the most serious complications of these procedures, since they are associated with serious, often life-threatening consequences. The aim of this study was to discover the factors that influence development of MRSA infections, as well as the development of the most serious complications of infection – limb loss and death. This retrospective study included patients who were operated because of the infection after vascular reconstruction, at the Division of Vascular Surgery, Department of Surgery, University Hospital Centre Zagreb, from 1996 to 2012. We analyzed patient characteristics, features of reconstructive procedure and hospital stay. Microbiological indicators of infection, mode of infection and treatment outcome were also analyzed. 118 patients out of 3518 had to be reoperated due to infection after vascular reconstruction. MRSA infection was noted in 49 (41.53%) patients. Amputation was performed in 12 (10.17%), and death occurred in 10 (8.48%) of patients operated for infection. Using synthetic infrainguinal grafts was shown to be a risk factor for the development of MRSA infections, as well as to be associated with the increased risk of amputation and death. Additional risk factors included patient age, diabetes, hypertension, smoking, duration of hospitalization and severity of infection. Results of this study confirm the findings of other studies around the world and underline the importance of effective chronic disease management, smoking cessation, short preoperative hospital stay and aggressive treatment of developed infection. In addition, the replacing synthetic grafts with autologous and heterologous grafts, and evaluating new possibilities of vascular disease treatment, could lead to reduction in the incidence of infection and its serious consequences after vascular reconstructions in the future