title: The impact of multiple operations on the importance of arterial wall cultures.
abstract: The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (chi 2 = 5.84; 0.01 less than p less than 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)--a culture obtained at initial vascular reconstruction--and group II (40 patients)--a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; chi 2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; chi 2 = 4.68; 0.025 less than p less than 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of high-dose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.
mesh_terms: D001158:Arteries / Q000382:microbiology*; D001807:Blood Vessel Prosthesis; D002511:Cephalosporins / Q000627:therapeutic use*; D006801:Humans; D011183:Postoperative Complications / Q000382:microbiology* / Q000517:prevention & control; D011292:Premedication; D011446:Prospective Studies; D012086:Reoperation; D013203:Staphylococcal Infections / Q000517:prevention & control; D014652:Vascular Diseases / Q000382:microbiology / Q000601:surgery*
chemical_list: D002511:Cephalosporins