The impact of multiple operations on the importance of arterial wall cultures

• Published in: Journal of vascular surgery Vol. 5; no. 1; pp. 160 - 169
• Main Authors: Durham, J.R., Malone, J.M., Bernhard, V.M.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-01-1987; Elsevier
• Subjects: Arteries - microbiology; Biological and medical sciences; Blood Vessel Prosthesis; Cephalosporins - therapeutic use; Humans; Medical sciences; Postoperative Complications - microbiology; Postoperative Complications - prevention & control; Premedication; Prospective Studies; Reoperation; Staphylococcal Infections - prevention & control; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vascular Diseases - microbiology; Vascular Diseases - surgery; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Human; Infection; Postoperative; Surgery; Microorganism culture; Lower limb; Cardiovascular disease; Complication; Arterial disease of the limb; Vascular wall; Artery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(87)90206-0

The present study reviewed arterial culture data from 172 patients undergoing major vascular reconstructions between July 1, 1977, and Dec. 31, 1984. Prosthetic graft infection was documented in 0 of 97 cases (0%) with negative arterial cultures but in six of 75 cases (8%) with positive arterial cultures (x2 = 5.84; 0.01 < p < 0.025). The data were reanalyzed after the patients were subdivided into two groups on the basis of the numbers of operations: group I (132 patients)—a culture obtained at initial vascular reconstruction—and group II (40 patients)—a culture obtained at a subsequent vascular reconstruction. Positive arterial cultures had no predictive value for graft infection among patients in group I (1 of 57 cases vs. 0 of 75 cases; x2 = 0.019), whereas the presence of positive arterial cultures was associated with a significant increase in the incidence of graft infection in group II patients (5 of 18 cases vs. 0 of 22 cases; x2 = 4.68; 0.025 < p < 0.05). For group I patients, we believe that neither routine arterial culture nor long-term antibiotic therapy for patients with positive arterial cultures is indicated. For group II patients we recommend that routine arterial cultures should be obtained; perioperative antibiotics should be continued until definitive arterial culture information is available; and positive arterial cultures should be treated with a short course of highdose intravenous antibiotics. Thereafter, long-term treatment of positive arterial cultures with oral antibiotics, although not statistically validated, is probably appropriate.