Antibiotic prophylaxis in clean surgery: vascular surgery.
The commonest and most dangerous infective complication in vascular surgery is prosthetic graft infection. Despite the use of routine systemic antibiotic prophylaxis, graft infection occurs after 3-5% of all prosthetic vascular reconstructions. Infection is associated with a high rate of major morbidity and mortality, with significant time and cost implications. Management can be difficult and the outcome is often disappointing. Data from Italian Registry of Prosthetic Graft Infections show that the commonest site of infection is the aorto-femoral district and that involved bacteria are usually gram-positive in early and low-grade infections and gram-negative in late and high-grade infections. Results are poor, with a mortality rate of 15% for elective surgery and of 60% for emergency interventions. We report the results of a multicenter randomized controlled trial of rifampicin-bonded Dacron grafts in aorto-femoral surgery, in which our Department was involved. Data demonstrate a reduction in total early wound and graft infection rates, and 2-year results show a small, non-significant reduction in graft infection (1.7% in study group, 2.3% in control group). The same results were obtained in two other multicenter trials.
Pratesi
C
C
Scuola di Specializzazione in Chirurgia Vascolare, University of Florence, Italy. Correspondence: Professor Carlo Pratesi, Cattedra di Chirurgia Vascolare, Ospedale di Careggi, Viale Morgagni 85, 50134 Firenze, Italy.
Russo
D
D
Dorigo
W
W
Chiti
E
E
D019072:Antibiotic Prophylaxis; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006801:Humans; D015337:Multicenter Studies as Topic; D011093:Polyethylene Terephthalates; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000627:therapeutic use*; D014656:Vascular Surgical Procedures
D000904:Antibiotics, Antitubercular; D011093:Polyethylene Terephthalates; D012293:Rifampin