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Inadequate perioperative prophylaxis and postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections – prospective results from the VASGRA Cohort Study


Anagnostopoulos, Alexia; Ledergerber, Bruno; Kuster, Stefan P; Scherrer, Alexandra U; Näf, Bettina; Greiner, Michael A; Rancic, Zoran; Kobe, Adrian; Bettex, Dominique; Hasse, Barbara (2019). Inadequate perioperative prophylaxis and postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections – prospective results from the VASGRA Cohort Study. Clinical Infectious Diseases, 69(4):621-630.

Abstract

Introduction Reconstructive vascular surgery has become increasingly common. Vascular graft infections (VGI) are serious complications leading to increased morbidity and mortality. Previously described risk factors for VGI include groin incision, wound infections, and comorbidities. We aimed to identify modifiable predictors for VGI as targets for infection prevention strategies. Methods Participants of the prospective Vascular Graft Infection Cohort (VASGRA) with surgery between 2013 and 2017 were included. Observation time was calculated from surgery until confirmed VGI or last follow-up. Variables were assessed by infection status using non-parametric tests. Uni- and multivariable Cox proportional hazard regression models, adjusted for demographic factors, were applied to assess risk factors for a VGI. Results A total of 438, predominantly male (83.1%) patients with a median age of 71 years (IQR 63–76) contributed to 554 person-years (PY) of follow-up. Thereof, 39 (8.9%) developed a vascular graft infection, amounting to an incidence rate of 7.0/100 PY. We found incisional surgical site infections (aHR 10.09 [2.88–35.34]), hemorrhage (aHR 4.92 [1.28–18.94]), renal insufficiency (aHR 4.85 [1.20–19.61]), inadequate perioperative prophylaxis in patients with an established antibiotic treatment compared to additional application of perioperative prophylaxis (aHR 2.87 [95%CI 1.17–7.05]), and procedure time per 1-hour increase (aHR 1.22 [95% CI 1.08–1.39]) to be risk factors for VGI. Conclusions We identified procedure time, inadequate perioperative prophylaxis, especially among patients with an established antibiotic treatment, and several postsurgical infectious and non-infectious complications as modifiable predictive factors for VGI and therefore key to improved surveillance programs and prevention strategies.

Abstract

Introduction Reconstructive vascular surgery has become increasingly common. Vascular graft infections (VGI) are serious complications leading to increased morbidity and mortality. Previously described risk factors for VGI include groin incision, wound infections, and comorbidities. We aimed to identify modifiable predictors for VGI as targets for infection prevention strategies. Methods Participants of the prospective Vascular Graft Infection Cohort (VASGRA) with surgery between 2013 and 2017 were included. Observation time was calculated from surgery until confirmed VGI or last follow-up. Variables were assessed by infection status using non-parametric tests. Uni- and multivariable Cox proportional hazard regression models, adjusted for demographic factors, were applied to assess risk factors for a VGI. Results A total of 438, predominantly male (83.1%) patients with a median age of 71 years (IQR 63–76) contributed to 554 person-years (PY) of follow-up. Thereof, 39 (8.9%) developed a vascular graft infection, amounting to an incidence rate of 7.0/100 PY. We found incisional surgical site infections (aHR 10.09 [2.88–35.34]), hemorrhage (aHR 4.92 [1.28–18.94]), renal insufficiency (aHR 4.85 [1.20–19.61]), inadequate perioperative prophylaxis in patients with an established antibiotic treatment compared to additional application of perioperative prophylaxis (aHR 2.87 [95%CI 1.17–7.05]), and procedure time per 1-hour increase (aHR 1.22 [95% CI 1.08–1.39]) to be risk factors for VGI. Conclusions We identified procedure time, inadequate perioperative prophylaxis, especially among patients with an established antibiotic treatment, and several postsurgical infectious and non-infectious complications as modifiable predictive factors for VGI and therefore key to improved surveillance programs and prevention strategies.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
04 Faculty of Medicine > University Hospital Zurich > Institute of Intensive Care Medicine
04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Microbiology (medical), Infectious Diseases
Language:English
Date:1 August 2019
Deposited On:28 Nov 2018 15:38
Last Modified:17 Sep 2019 19:45
Publisher:Oxford University Press
ISSN:1058-4838
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/cid/ciy956
PubMed ID:30395220

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