title: Significance of infection markers and microbiological findings during tissue processing of cryopreserved arterial homografts for the early postoperative course.
abstract: BACKGROUND
  To evaluate homograft implantation for the urgent treatment of vascular infections on the basis of the course of infection using microbiological findings in perioperatively obtained specimens and during homograft processing.
  
  
  METHODS
  85 patients were treated with cryopreserved homografts from 2004-2007. The microbiological findings of the decontamination process of homografts in the tissue bank were evaluated. The perioperative infection profile (microorganisms, CRP, leukocytes, body temperature) of the patients was analysed.
  
  
  RESULTS
  Complete microbiological and clinical follow-up for the postoperative course was available for 35 patients, who were treated with homografts from the same tissue bank and finally included into this study. 55 cryopreserved homografts were implanted. 35/55 (64%) homografts were positive for microorganisms before decontamination. 3/35 (9%) homografts remained positive after the decontamination. 33 patients were operated for prosthetic graft infection and 2 for an infiltration of a large vessel from neighbouring malignant disease. The most common infection agent was Staphylococcus aureus. Thirty-day mortality was 20% (7/35). Only in 4/35 (11%) patients were the microorganisms of the intraoperative swabs also detected during the postoperative course. The microorganisms were ORSA, Enterococcus faecium, Enterobacter aerogenes and Burkholderia cepacia. The patient with ORSA infection died on POD 11 from multiple organ failure and all other patients recovered. None of the postoperative swabs showed the homograft predecontamination microorganisms. Interestingly, a significant association (P = 0.003) between C-reactive protein increase two weeks after surgery and donor-recipient ABO mismatch was found.
  
  
  CONCLUSIONS
  The implantation of homografts following the established decontamination is an alternative urgent therapeutic option in vascular infections with encouraging outcomes. The absence of the predecontamination focus in the postoperative specimens of patients, suggests that the postoperative course and outcomes show no strong relation to potential homograft contamination prior to the decontamination process.
authors.affiliation: Hannover Medical School, Dept. of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany.
authors.forename: T E
authors.initials: TE
authors.lastname: Bisdas
authors.forename: F
authors.initials: F
authors.lastname: Mattner
authors.forename: E
authors.initials: E
authors.lastname: Ott
authors.forename: M A
authors.initials: MA
authors.lastname: Pichlmaier
authors.forename: M
authors.initials: M
authors.lastname: Wilhelmi
authors.forename: A
authors.initials: A
authors.lastname: Haverich
authors.forename: O
authors.initials: O
authors.lastname: Teebken
mesh_terms: D000368:Aged; D000785:Aneurysm, Infected / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001158:Arteries / Q000382:microbiology / Q000637:transplantation*; D001788:Blood Grouping and Crossmatching; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D015925:Cryopreservation; D003666:Decontamination; D005260:Female; D006085:Graft Survival; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D011651:Pulmonary Artery / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D012086:Reoperation; D013997:Time Factors; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous; D016896:Treatment Outcome