Coagulase-negative staphylococcal infections in vascular surgery: epidemiology and pathogenesis.
Staphylococcal infection of a vascular prosthesis is a relatively uncommon complication of peripheral vascular surgery; however, these infections and their sequelae can be catastrophic. The majority of prosthetic graft infections are caused by mucin-producing strains of Staphylococcus epidermidis, which express varying degrees of adherence to the synthetic substrates. Studies have demonstrated that the components and construction characteristics of the graft, implantation site, administration of antimicrobial agents, and endogenous microbial flora are all identifiable risk factors in vascular graft infections. Mucin production, a known virulence factor, has recently been shown to occur in endogenous coagulase-negative staphylococci (CNS) at the time of hospital admission. While mucin production plays an important role in the persistence of graft infections, there is no evidence that suggests a relationship between mucin and antimicrobial resistance. Identifying characteristics of (CNS) graft infections may include a draining wound sinus, poor graft incorporation, a perigraft exudate or a pseudoaneurysm at the anastomotic site. The occult nature of these infections, in which the patient is often asymptomatic, makes diagnosis and treatment difficult. The graft or graft exudate may be negative when routine culture methods are employed. The recognition of CNS graft infections requires a high index of suspicion and the treatment of these infections requires understanding of the pathogenic process, individualized surgical management, and the judicious use of antimicrobial agents.
Edmiston
C E
CE
Department of Surgery, Medical College of Wisconsin, Milwaukee.
Schmitt
D D
DD
Seabrook
G R
GR
D001807:Blood Vessel Prosthesis; D003030:Coagulase / Q000032:analysis*; D003428:Cross Infection / Q000382:microbiology*; D003430:Cross-Sectional Studies; D006801:Humans; D008855:Microscopy, Electron, Scanning; D013203:Staphylococcal Infections / Q000382:microbiology*; D013212:Staphylococcus epidermidis / Q000472:pathogenicity; D013499:Surface Properties; D013530:Surgical Wound Infection / Q000382:microbiology*
D003030:Coagulase