title: Outcomes of infected abdominal aortic grafts managed with antimicrobial therapy and graft retention in an unselected cohort.
abstract: OBJECTIVE
  To document the treatment of all patients with infected aortic grafts at Christchurch Hospital between 1999 and 2010, focussing on the mortality and morbidity of those treated without graft explantation.
  
  
  METHODS
  Cases of infected aortic grafts were reviewed. Cases required a compatible clinical syndrome, CT imaging and tissue/blood culture results.
  
  
  RESULTS
  Eighteen patients were identified. Organisms isolated at diagnosis from blood or graft site were Staphylococcus aureus 6 (MRSA 1), beta haemolytic streptococci 2, enteric organisms 9.There was no isolate from 2. One case had graft explantation and brief antimicrobial therapy. Seventeen patients had the graft retained. Of these, 14 received intravenous antimicrobial therapy for 6 weeks and 14 lifelong oral therapy. None died during their initial admission or within 30 days. During a mean follow-up of 57 months, 10 (59%) relapsed (median time 31 months, range 0--98), 4 (24%) underwent graft explantation and 10 (59%) died (median 40 months, range 1e 198). Four of 10 who relapsed had organisms isolated (all enteric).
  
  
  CONCLUSIONS
  Patients treated with lifelong antimicrobial therapy and graft retention survived a median of 41 months, with low early mortality although over half relapsed. Empiric therapy should cover skin organisms and enteric organisms, even for those outside the post-operative period.
authors.affiliation: Department of Infectious Diseases, Christchurch Hospital, New Zealand.
authors.forename: M J
authors.initials: MJ
authors.lastname: Maze
authors.forename: P
authors.initials: P
authors.lastname: Laws
authors.forename: T
authors.initials: T
authors.lastname: Buckenham
authors.forename: A
authors.initials: A
authors.lastname: Pithie
authors.forename: K
authors.initials: K
authors.lastname: Gallagher
authors.forename: S
authors.initials: S
authors.lastname: Metcalf
authors.forename: J
authors.initials: J
authors.lastname: Roake
authors.forename: S T
authors.initials: ST
authors.lastname: Chambers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D020878:Device Removal; D004334:Drug Administration Schedule; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009520:New Zealand; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013291:Streptococcus / Q000302:isolation & purification; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents