Mun Jye Poi MD, George Pisimisis MD, Neal Barshes MD MPH, Peter H. Lin MD, Panagiotis Kougias MD, Carlos F. Bechara MD
Baylor College of Medicine; Houston, TX.
OBJECTIVES: The objective is to evaluate effectiveness of antibiotic-based polymethylmethacrylate (ab-PMMA) beads in treating vascular graft infections.
METHODS: We reviewed 31 patients treated for 32 graft infections over the past 5 years using ab-PMMA beads in a single institution. All patients were started on broad spectrum antibiotics and later switched to targeted therapy based on intra-operative cultures for at least 6 weeks. All patients underwent multiple planned wound explorations, debridements and washouts. Cultures were obtained each time. Decision to do formal closure depended on culture results and wound appearance. All wounds were closed with a muscle flap. Our endpoints included limb salvage, recurrence of infection and graft preservation.
RESULTS: A total of 19 different organisms were isolated and 47% of cases were polymicrobial. The majority (n=23) received a mix of tobramycin/vancomycin PMMA beads, vancomycin beads (n=5), tobramycin beads (n=1) and gentamicin/vancomycin beads (3). Wound sterilization based on cultures was achieved in 28 cases (87.5%) with graft preservation. Four patients underwent early graft removal, three with immediate reconstruction. No death occurred within 30 days and one patient underwent a major amputation (3.1%). Limb salvage was achieved in 86.6% of the preserved graft group at a mean of 24.5 months (3-48 months). Four patients presented with graft occlusion and acute limb ischemia resulting in major amputation at 2.5, 7, 23 and 26 months. All 4 had evidence of recurrent graft infection (13.3%).
CONCLUSIONS: Sterilization of graft infection can be achieved with ab-PMMA beads followed by closure with muscle flap resulting in acceptable limb salvage rate.
AUTHOR DISCLOSURES: M. Poi, Nothing to disclose; G. Pisimisis, Nothing to disclose; N. Barshes, Nothing to disclose; P. Lin, Nothing to disclose; P. Kougias, Nothing to disclose; C. Bechara, Nothing to disclose.
Posted April 2012