title: Arteriovenous graft infection: a comparison of thigh and upper extremity grafts.
abstract: OBJECTIVE
  There are a limited number of publications on the features of arteriovenous graft infection in hemodialysis patients. The authors compared the clinical presentation, complications, and outcomes of infections of thigh and upper extremity grafts.
  
  
  METHODS
  The authors queried a prospective access database at a large university medical center and identified 132 patients with graft infections (40 in the thigh and 92 in the upper extremity) requiring surgical excision. The authors collected information regarding the microbiology, complications, and clinical outcomes.
  
  
  RESULTS
  The two graft groups were similar in age, gender, race, and frequency of diabetes. The median age of infected grafts was 162 days for thigh grafts versus 168 days for upper extremity grafts (P = 0.35). Thigh graft infections were more likely than upper extremity graft infections to be caused by a Gram-negative rod (31% versus 4%; P = 0.003), and more likely to result in a metastatic infection (15% versus 3%; P = 0.02). The duration of hospitalization associated with graft infection was similar (10.8 ± 5.4 versus 8.7 ± 6.3 days; P = 0.09). Finally, median catheter dependence was longer after thigh graft than upper arm graft infections (319 versus 237 days; P = 0.04).
  
  
  CONCLUSIONS
  As compared with upper extremity graft infections, thigh graft infections requiring excision are more likely to be caused by Gram-negative bacteria and to result in serious metastatic complications. These differences may require different empiric antibiotics and a higher index of suspicion for infection in hemodialysis patients with thigh grafts.
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. mdallon@uab.edu
authors.forename: Abha
authors.initials: A
authors.lastname: Harish
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000407:Alabama; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D006435:Renal Dialysis; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D013848:Thigh / Q000098:blood supply*; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000098:blood supply*
chemical_list: D000900:Anti-Bacterial Agents