rifampin and Aortic-Diseases

We compared pooled estimates of event rates for amputations, conduit failures, reinfections, early mortalities, and late mortalities in patients with aortic graft infection who were treated by extra-anatomic bypass, rifampicin-bonded prostheses, cryopreserved allografts, or autogenous veins.. A systematic review was conducted of English language reports in MEDLINE back to 1985 and a meta-analysis was performed on the results. Studies were selected on the basis of medical subject headings aortic, graft, and infection, and also by a standardized and independent quality rating. Inclusion and exclusion criteria were met by 37 clinical studies. Pooled estimates of mean event rates for amputations, conduit failures, reinfections, early (< or =30 day) mortalities, and late (>30 days) mortalities were determined for each treatment modality. Tests of heterogeneity and sensitivity analyses were performed.. Fixed effect analyses, derived after tests of heterogeneity, yielded overall pooled estimates of mean event rates for all outcomes combined of 0.16 for extra-anatomic bypass, 0.07 for rifampicin-bonded prostheses, 0.09 for cryopreserved allografts, and 0.10 for autogenous vein; a lower value signifies fewer overall events associated with the treatment modality. Overall, the robustness of our meta-analysis was demonstrated by the reasonable heterogeneity of pooled data from individual studies (Q statistic <25; P >.1 for all treatment outcomes across all modalities) and the limited variability of outcomes after sensitivity analyses.. Although limited by the design of individual published studies whose data were pooled together in this meta-analysis, our results lead to questions concerning whether extra-anatomic bypass should remain the gold standard for treatment of aortic graft infection.

Topics: Antibiotics, Antitubercular; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessels; Cryopreservation; Humans; Prosthesis-Related Infections; Rifampin; Transplantation, Autologous; Treatment Outcome

A 68-year-old woman underwent replacement of the ascending aorta for acute type A aortic dissection. She was then diagnosed with postoperative methicillin-resistant Staphylococcus aureus (MRSA) infection, and the infected aortic graft was replaced with a rifampicin-soaked vascular prosthesis, which was followed by continuous irrigation using a 0.1% povidone-iodine solution. The postoperative course was uneventful, and she has been doing well for 5 years with no recurrence of infection. Prosthetic graft replacement using a rifampicin-soaked graft followed by continuous irrigation with povidone-iodine is useful for treatment of an MRSA-infected prosthetic vascular graft.

Topics: Aged; Aorta; Aortic Diseases; Blood Vessel Prosthesis Implantation; Female; Humans; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Prosthesis-Related Infections; Rifampin

Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.

Topics: Abattoirs; Aged; Animals; Anti-Bacterial Agents; Aortic Diseases; Bacteremia; Blood Vessel Prosthesis; Brucella abortus; Brucellosis; Doxycycline; Ecuador; Endarteritis; Endocarditis, Bacterial; Gentamicins; Humans; Male; Occupational Exposure; Prognosis; Rifampin; Ulcer

Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome.. This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection.. Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate.. We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.

Topics: Aged; Antibiotics, Antitubercular; Aortic Diseases; Blood Vessel Prosthesis; Female; Humans; Infections; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Rifampin; Vascular Surgical Procedures

We previously reported that in situ rifampin-soaked grafts (ISRGs) were safe in select patients with aortic graft infections, with the best results in those with aortic graft enteric erosion or fistula (AGEF). This study evaluates the late results of ISRG for AGEF.. From 1990 to 2008, 183 patients were treated for aortic graft infections (121 primary and 62 AGEF). We reviewed 54 patients treated for AGEF with a standard protocol, which included excision of the infected part of the graft, intestinal repair, ISRG with omental wrap, and long-term antibiotics. We excluded 8 patients with AGEF (13%) treated with axillofemoral grafts (AXFG, n = 5) or in situ femoral vein (n = 3) due to excessive perigraft purulence. Endpoints were early morbidity and mortality, late survival, reinfection, and graft-related complications.. There were 45 male patients and 9 female patients with a mean age of 69 ± 9 years. Presentation was gastrointestinal bleeding in 33 patients, fever in 25 patients, and hemorrhagic shock in 10 patients. Other features were perigraft fluid in 29 patients and purulence in 9 patients. Forty-two patients (80%) had infections isolated to a portion of the graft body or limb, with the remainder of the graft well incorporated. Total graft excision was performed in 31 patients and partial excision in 23 patients. Total operating time was 6.2 ± 1.9 hours. Postoperative complications occurred in 28 patients (52%), and there were 5 deaths (9%). Operative mortality was 2.3% in stable patients (1 of 44) and 40% in those with hemorrhagic shock (4 of 10; P < .001). The hospital stay was 20 ± 18 days. Mean follow-up was 51 months (range, 3-197 months). Five-year patient survival, primary graft patency, and limb salvage rates were 59 ± 8%, 92 ± 5%, and 100%, respectively. There were no late graft-related deaths. There were two (4%) graft reinfections, one that was treated with axillofemoral bypass, and the other with perigraft fluid aspiration and oral antibiotic suppression.. ISRGs with omental wrap and long-term antibiotics are associated with low reinfection rates in patients with AGEF who do not have excessive perigraft purulence. Graft patency and limb salvage rates are excellent.

Topics: Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Female; Humans; Male; Omentum; Prosthesis-Related Infections; Recurrence; Retrospective Studies; Rifampin; Vascular Fistula; Vascular Patency

Aortoesophageal fistula secondary to thoracic aneurysm is rare, but is usually lethal, and few survivors have been reported. We report successful surgery for aortoesophageal fistula in a one-stage operation. Repair involved in situ replacement of the thoracic aneurysm using a rifampicin-soaked graft, primary repair of the esophagus, omental wrap and tube jejunostomy. This is the original report of the surgical repair of aortoesophageal fistula using a rifampicin-soaked graft.

Topics: Anti-Infective Agents; Aortic Aneurysm, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Enteral Nutrition; Esophageal Fistula; Esophagoscopy; Esophagus; Humans; Jejunostomy; Omentum; Prosthesis Design; Prosthesis-Related Infections; Rifampin; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome; Vascular Fistula

Secondary aortoenteric fistulas remain challenging diagnostic and therapeutic problems. Although the duodenum is most frequently involved, other intestinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleeding 11 years after abdominal aortic aneurysm replacement. The preoperative diagnosis was not achieved by endoscopy or imaging assessment. Despite recommended principles of total graft excision and extraanatomic bypass, appendectomy and in situ rifampin-bonded graft reconstruction were performed because of the advanced age and poor arterial runoff. The postoperative course was uneventful and the patient remains well 17 months after operation.

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Diseases; Appendix; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cecal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Polyethylene Terephthalates; Postoperative Complications; Rifampin; Time Factors; Vascular Fistula

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Diseases; Blood Vessel Prosthesis; Female; Humans; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections; Rifampin