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Predictive Factors for Aortic Graft Infection: A Case-Control Study

  • António Duarte
    Correspondence
    Correspondence to: Antonio Duarte, Hospital de Santa Maria – Centro Hospitalar Universitário Lisboa Norte, EPE, Serviço de Angiologia e Cirurgia Vascular, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
    Affiliations
    Division of Vascular Surgery, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Lisbon Academic Medical Centre, Lisbon, Portugal
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  • Ryan Gouveia e Melo
    Affiliations
    Division of Vascular Surgery, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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  • Diogo Mendes Pedro
    Affiliations
    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Department of Infectious Diseases, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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  • Beatriz Martins
    Affiliations
    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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  • Gonçalo Sobrinho
    Affiliations
    Division of Vascular Surgery, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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  • Ruy Fernandes e Fernandes
    Affiliations
    Division of Vascular Surgery, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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  • Carla Mimoso Santos
    Affiliations
    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal

    Department of Infectious Diseases, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Local Coordination Group - Program for Prevention and Control of Infections and Antimicrobial Resistance (GCL-PPCIRA), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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  • Luís Mendes Pedro
    Affiliations
    Division of Vascular Surgery, Heart and Vessels Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal

    Lisbon Academic Medical Centre, Lisbon, Portugal

    Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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      Highlights

      • Graft infections remain one of the most serious complications in vascular surgery.
      • Malignancy and alcoholism seem to increase the risk for aortic graft infection.
      • Effective strategies to mitigate this complication must be a top priority.

      Background

      Graft infections are one of the most serious complications in vascular surgery, with high mortality rates. Few studies addressed risk factors associated with a higher susceptibility to infection. The aim of this study is to identify perioperative factors associated with aortic graft infections (AGI).

      Methods

      We designed a retrospective, case-control study from patients subjected to open aortic repair between 2013 and 2019. Cases of AGI were defined according to the management of aortic graft infection collaboration (MAGIC) criteria and matched to controls without proven infection. Demographics, hospital complications, and laboratory workups were assessed. Predictors of AGI were identified through univariate and multivariate analysis.

      Results

      Most graft infections occurred in a late period (n = 17; 85%), after a median interval of 13.5 months interquartile range (IQR 1.5–36). Gram-negative bacteria were most frequently isolated in infected grafts, namely Enterobacteriaceae (n = 12). Cases had significantly lower postoperative serum albumin levels (1.9 g/dL vs. 2.4 g/dL; P = 0.002). Alcohol abuse, malignancy, prolonged lengths of stay, wound infection and dehiscence, in-hospital infection, postoperative heart failure or bowel ischemia were significantly correlated to the onset of AGI. In the multivariate analysis, prolonged hospital stays odds ratio (OR 1.05; P = 0.03), malignancy (OR 5.82; P = 0.03) and alcohol abuse (OR 42.41; P = 0.002) maintained a significant association.

      Conclusions

      The risk of AGI seems to be higher in patients with concurrent malignancy, alcohol abuse or prolonged hospital stays. Strategies to mitigate this complication in these patients are of utmost importance.
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