title: Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections.
abstract: OBJECTIVE
  There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction.
  
  
  METHODS
  A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted.
  
  
  RESULTS
  Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012-2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3 ± 8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival.
  
  
  CONCLUSIONS
  This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.
authors.affiliation: Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA genovesee@upmc.edu.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Genovese
authors.affiliation: Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Efthymios D
authors.initials: ED
authors.lastname: Avgerinos
authors.affiliation: Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Donald T
authors.initials: DT
authors.lastname: Baril
authors.affiliation: Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Makaroun
authors.affiliation: Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Chaer
mesh_terms: D020341:Absorbable Implants; D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003646:Debridement; D020878:Device Removal; D004337:Drug Carriers; D004338:Drug Combinations; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012086:Reoperation; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D004337:Drug Carriers; D004338:Drug Combinations; D005839:Gentamicins; D014640:Vancomycin; D012293:Rifampin
keywords: Prosthesis-related infections; anti-bacterial agents; drug implants