Use of antibiotic-bonded grafts in vascular graft infection

Abstract

Because the morbidity and mortality after treatment of an established vascular infection is prohibitively high, prevention of local infection should be the primary aim, especially if a prosthetic graft has to be used. Once the infection has occurred, the infected graft must usually be removed. Extra-anatomic bypass or autograft replacement with arterial or venous conduits are frequently used for revascularisation of non-viable organs or extremities. Recently in situ implantation of allografts or prosthetic grafts has been considered as a possible alternative in high risk patients or in patients with poor run-off if complex secondary revascularisation was not feasible. I-5 Many methods have been described to create an infection-resistant graft, binding various antibacterial substances to the vascular prostheses. 6-11 This paper documents our clinical experience with the rifampicin-bonded graft. Eight patients were operated on as an emergency. Seven patients had total graft replacement and four partial replacement of the graft for infection limited to the groin (Fig. 1). The treatment consisted of parenteral antibiotic treatment with oxacillin, accurate skin preparation, graft removal, generous wound debridement and local antiseptic treatment with betadine. After gloves and instruments had been changed a new gelatine-coated Dacron prosthesis was soaked with 600 mg rifampicin diluted with 10 ml NaC1 0.9% for 10-15 min before implantation. If residual contamination could not be excluded, continuous irrigation of the wound with betadine for 48-72 h was performed. All patients received postoperative intravenous antibiotics on the basis of the sensitivities. Bacteriological studies of the removed prosthesis showed Staphylococcus aureus in eight cases and Staphylococcus epidermidis in four.