Annals of vascular surgery · 2025
Duration of Antimicrobial Treatment After Total Explantation of Infected Abdominal Aortic Vascular Grafts: A Systematic Review.
СтатьяСистематический обзорНазвание и аннотация: Перевод в очереди
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Cremer K, Wouthuyzen-Bakker M, Kouijzer I J E, Saleem B R, de Vries J P P M, van Roeden S E
Аннотация
BACKGROUND: Vascular graft or endograft infection (VGEI) is a rare but severe complication of vascular surgery, associated with high mortality. In addition to surgical intervention, targeted antimicrobial treatment is essential. However, current guidelines lack consensus on the optimal postoperative treatment duration. This systematic review evaluates the optimal length of antimicrobial treatment in patients with abdominal VGEI after total graft explantation.
DESIGN: Systematic review.
METHODS: A comprehensive search was conducted in PubMed, Embase, and Cochrane Library databases up to December 19, 2024. Eligible studies reported on antimicrobial treatment following total explantation of infected abdominal vascular grafts, including cases with graft-related fistulas. Exclusion criteria comprised studies on partial graft explantation, specific microorganisms causing distinct clinical diseases (Coxiella burnetii, Brucella species), mycobacterial infections, infected native aortoiliac aneurysms, and thoracic and peripheral VGEI. The primary outcome was all-cause mortality; secondary outcomes included 30-day mortality, infection-free survival, infection recurrence, and graft patency. Risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Of 132 screened studies, 7 retrospective cohort studies comprising 776 patients met the inclusion criteria. Reported postoperative antimicrobial treatment durations ranged from 2 to 170 weeks (median 13 weeks), with some studies describing lifelong treatment. All-cause mortality varied between 23% and 57%. No association could be found between antimicrobial treatment duration and mortality.
DISCUSSION: Limitations include the retrospective design, leading to confounding by indication and information bias. Patient populations were heterogeneous, and follow-up durations were often insufficient for long-term outcome assessment. This review underscores the limited quality of evidence available on this topic and underlines the importance of good quality research.
CONCLUSION: The optimal postoperative antimicrobial treatment duration following complete explantation of infected abdominal grafts remains uncertain.
DESIGN: Systematic review.
METHODS: A comprehensive search was conducted in PubMed, Embase, and Cochrane Library databases up to December 19, 2024. Eligible studies reported on antimicrobial treatment following total explantation of infected abdominal vascular grafts, including cases with graft-related fistulas. Exclusion criteria comprised studies on partial graft explantation, specific microorganisms causing distinct clinical diseases (Coxiella burnetii, Brucella species), mycobacterial infections, infected native aortoiliac aneurysms, and thoracic and peripheral VGEI. The primary outcome was all-cause mortality; secondary outcomes included 30-day mortality, infection-free survival, infection recurrence, and graft patency. Risk of bias was assessed using the Newcastle-Ottawa Scale.
RESULTS: Of 132 screened studies, 7 retrospective cohort studies comprising 776 patients met the inclusion criteria. Reported postoperative antimicrobial treatment durations ranged from 2 to 170 weeks (median 13 weeks), with some studies describing lifelong treatment. All-cause mortality varied between 23% and 57%. No association could be found between antimicrobial treatment duration and mortality.
DISCUSSION: Limitations include the retrospective design, leading to confounding by indication and information bias. Patient populations were heterogeneous, and follow-up durations were often insufficient for long-term outcome assessment. This review underscores the limited quality of evidence available on this topic and underlines the importance of good quality research.
CONCLUSION: The optimal postoperative antimicrobial treatment duration following complete explantation of infected abdominal grafts remains uncertain.