title: Diagnosis of Aortic Graft Infection: A Case Definition by the Management of Aortic Graft Infection Collaboration (MAGIC).
abstract: OBJECTIVE
  The management of aortic graft infection (AGI) is highly complex and in the absence of a universally accepted case definition and evidence-based guidelines, clinical approaches and outcomes vary widely. The objective was to define precise criteria for diagnosing AGI.
  
  
  METHODS
  A process of expert review and consensus, involving formal collaboration between vascular surgeons, infection specialists, and radiologists from several English National Health Service hospital Trusts with large vascular services (Management of Aortic Graft Infection Collaboration [MAGIC]), produced the definition.
  
  
  RESULTS
  Diagnostic criteria from three categories were classified as major or minor. It is proposed that AGI should be suspected if a single major criterion or two or more minor criteria from different categories are present. AGI is diagnosed if there is one major plus any criterion (major or minor) from another category. (i) Clinical/surgical major criteria comprise intraoperative identification of pus around a graft and situations where direct communication between the prosthesis and a nonsterile site exists, including fistulae, exposed grafts in open wounds, and deployment of an endovascular stent-graft into an infected field (e.g., mycotic aneurysm); minor criteria are localized AGI features or fever ≥38°C, where AGI is the most likely cause. (ii) Radiological major criteria comprise increasing perigraft gas volume on serial computed tomography (CT) imaging or perigraft gas or fluid (≥7 weeks and ≥3 months, respectively) postimplantation; minor criteria include other CT features or evidence from alternative imaging techniques. (iii) Laboratory major criteria comprise isolation of microorganisms from percutaneous aspirates of perigraft fluid, explanted grafts, and other intraoperative specimens; minor criteria are positive blood cultures or elevated inflammatory indices with no alternative source.
  
  
  CONCLUSIONS
  This AGI definition potentially offers a practical and consistent diagnostic standard, essential for comparing clinical management strategies, trial design, and developing evidence-based guidelines. It requires validation that is planned in a multicenter, clinical service database supported by the Vascular Society of Great Britain & Ireland.
authors: Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Division, King's College London, London, UK.
authors: O T A
authors: OT
authors: Lyons
authors: Department of Vascular Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; School of Health Sciences, University of Salford, Salford, UK.
authors: M
authors: M
authors: Baguneid
authors: Department of Radiology & Nuclear Medicine, Imperial College Healthcare NHS, London, UK; Department of Surgery & Cancer, Imperial College London, London, UK.
authors: T D
authors: TD
authors: Barwick
authors: Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK.
authors: R E
authors: RE
authors: Bell
authors: Department of Medical Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors: N
authors: N
authors: Foster
authors: Department of Vascular Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Vascular Institute & Leeds Institute of Genetics, Health & Therapeutics (LIGHT), University of Leeds, Leeds, UK.
authors: S
authors: S
authors: Homer-Vanniasinkam
authors: Department of Infectious Diseases & Microbiology, Royal Free London NHS Foundation Trust, London, UK.
authors: S
authors: S
authors: Hopkins
authors: Public Health Laboratory Birmingham, National Infection Service, Public Health England, Birmingham, UK; School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, UK.
authors: A
authors: A
authors: Hussain
authors: Department of Interventional Radiology, Guy's & St Thomas' NHS Foundation Trust, London, UK; Department of Radiology, School of Medicine, University of Patras, Greece.
authors: K
authors: K
authors: Katsanos
authors: Department of Vascular Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK; Cardiovascular Division, King's College London, London, UK.
authors: B
authors: B
authors: Modarai
authors: Department of Medical Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Biomedical & Clinical Sciences, University of Leeds, Leeds, UK.
authors: J A T
authors: JA
authors: Sandoe
authors: Department of Microbiology, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors: S
authors: S
authors: Thomas
authors: Department of Infectious Diseases, Guy's & St Thomas' NHS Foundation Trust, London, UK. Electronic address: Nicholas.Price@gstt.nhs.uk.
authors: N M
authors: NM
authors: Price
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001011:Aorta / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods* / Q000592:standards; D001431:Bacteriological Techniques / Q000592:standards; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D000066491:Clinical Decision-Making; D000072226:Computed Tomography Angiography / Q000592:standards; D032921:Consensus; D020878:Device Removal; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D004739:England; D006801:Humans; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy; D013222:State Medicine; D015607:Stents / Q000009:adverse effects*; D009626:Terminology as Topic; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: (Endo)Graft; Aortic; Definition; Diagnosis; Infection; Prosthetic; Stent-graft