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Infektionen von Gefäßprothesen

Möglichkeiten ihrer Prophylaxe

Infections of vascular prostheses

Options for prophylaxis

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Zusammenfassung

Infektionen von Gefäßprothesen sind schwerwiegende Komplikationen von rekonstruktiven gefäßchirurgischen Eingriffen mit hoher konsekutiver Amputationsrate und Letalität. Ihre Pathogenese ist multifaktoriell, und dementsprechend existieren verschiedenste prophylaktische Ansätze. Neben den Grundsätzen der chirurgischen Asepsis werden zusätzliche Maßnahmen zur Verbesserung der hygienischen Bedingungen in der perioperativen Phase angewandt. Die perioperative Antibiotikaprophylaxe ist in diesem Zusammenhang das einzige Mittel, das einen gewissen Evidenzgrad in Bezug auf die Senkung der Rate von Protheseninfekten erreicht hat. Modifikationen von Prothesen zur Steigerung ihrer Infektresistenz z. B. durch Rifampicin- oder Silberbindung sind seit Langem in Gebrauch, die Datenlage hierfür ist allerdings nicht eindeutig und Gegenstand weiterer Untersuchungen. Ähnliches gilt für die lokale Antibiotikaapplikation z. B. in Form von Gentamicin-Kollagen-Schwämmen. Neue Technologien und antimikrobielle Substanzen werden hier in Zukunft möglicherweise einmal die komplett infektresistente Prothese schaffen.

Abstract

Graft infections are serious complications of vascular reconstructive interventions with high amputation and mortality rates. The pathogenesis is multifactorial and thus there are different preventive approaches. Besides the fundamentals of surgical asepsis, additional measures have been applied to improve perioperative hygienic conditions. Perioperative antibiotic prophylaxis is the only method which attains a certain degree of evidence in terms of reducing the rate of vascular graft infections. Modifications of vascular grafts to enhance the resistance to infection, e.g. rifampicin or silver bonding, have been used for several years but the body of evidence supporting the application is limited and subject to further investigation. Similarly, there is a lack of clear data for the use of local antibiotics, e.g. gentamicin-collagen sponges. In the future novel technologies and antimicrobial substances may make it possible to create a graft which is totally resistant to infection.

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Literatur

  1. Antonios VS, Noel AA, Steckelberg JM et al (2006) Prosthetic vascular graft infection: a risk factor analysis using a case-control study. J Infect 53:49–55

    Article  PubMed  Google Scholar 

  2. Bandyk DF (2008) Vascular surgical site infection: risk factors and preventive measures. Semin Vasc Surg 21:119–123

    Article  PubMed  Google Scholar 

  3. Bennett-Guerrero E, Ferguson TB Jr, Lin M et al (2010) Effect of an implantable gentamicin-collagen sponge on sternal wound infections following cardiac surgery: a randomized trial. JAMA 304:755–762

    Article  PubMed  CAS  Google Scholar 

  4. Bennett-Guerrero E, Pappas TN, Koltun WA et al (2010) Gentamicin-collagen sponge for infection prophylaxis in colorectal surgery. N Engl J Med 363:1038–1049

    Article  PubMed  CAS  Google Scholar 

  5. Braithwaite BD, Davies B, Heather BP et al (1998) Early results of a randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction. Joint Vascular Research Group. Br J Surg 85:1378–1381

    Article  PubMed  CAS  Google Scholar 

  6. Brothers TE, Robison JG, Elliott BM (2009) Predictors of prosthetic graft infection after infrainguinal bypass. J Am Coll Surg 208:557–561

    Article  PubMed  Google Scholar 

  7. Cirioni O, Giacometti A, Ghiselli R et al (2007) The lipopeptides Pal-Lys-Lys-NH(2) and Pal-Lys-Lys soaking alone and in combination with intraperitoneal vancomycin prevent vascular graft biofilm in a subcutaneous rat pouch model of staphylococcal infection. Peptides 28:1299–1303

    Article  PubMed  CAS  Google Scholar 

  8. D’Addato M, Curti T, Freyrie A (1996) Prophylaxis of graft infection with rifampicin-bonded Gelseal graft: 2-year follow-up of a prospective clinical trial. Italian Investigators Group. Cardiovasc Surg 4:200–204

    Article  Google Scholar 

  9. D’Addato M, Curti T, Freyrie A (1997) The rifampicin-bonded gelseal graft. Eur J Vasc Endovasc Surg 14(Suppl A):15–17

    Article  Google Scholar 

  10. Dawson-Bowling S, Smith J, Butt D et al (2011) Should outer surgical gloves be changed intraoperatively before orthopaedic prosthesis implantation? J Hosp Infect 78:156–157

    Article  PubMed  CAS  Google Scholar 

  11. Dettenkofer M, Wilson C, Gratwohl A et al (2010) Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clin Microbiol Infect 16:600–606

    Article  PubMed  CAS  Google Scholar 

  12. Dewan PA, Van Rij AM, Robinson RG et al (1987) The use of an iodophor-impregnated plastic incise drape in abdominal surgery – a controlled clinical trial. Aust N Z J Surg 57:859–863

    Article  PubMed  CAS  Google Scholar 

  13. Earnshaw JJ (2000) The current role of rifampicin-impregnated grafts: pragmatism versus science. Eur J Vasc Endovasc Surg 20:409–412

    Article  PubMed  CAS  Google Scholar 

  14. Earnshaw JJ, Whitman B, Heather BP (2000) Two-year results of a randomized controlled trial of rifampicin-bonded extra-anatomic dacron grafts. Br J Surg 87:758–759

    Article  PubMed  CAS  Google Scholar 

  15. Fairclough JA, Johnson D, Mackie I (1986) The prevention of wound contamination by skin organisms by the pre-operative application of an iodophor impregnated plastic adhesive drape. J Int Med Res 14:105–109

    PubMed  CAS  Google Scholar 

  16. Frei E, Hodgkiss-Harlow K, Rossi PJ et al (2011) Microbial pathogenesis of bacterial biofilms: a causative factor of vascular surgical site infection. Vasc Endovascular Surg, doi: 10.1177/1538574411419528

  17. Friberg O, Svedjeholm R, Soderquist B et al (2005) Local gentamicin reduces sternal wound infections after cardiac surgery: a randomized controlled trial. Ann Thorac Surg 79:153–161

    Article  PubMed  Google Scholar 

  18. Gao H, Sandermann J, Prag J et al (2010) Prevention of primary vascular graft infection with silver-coated polyester graft in a porcine model. Eur J Vasc Endovasc Surg 39:472–477

    Article  PubMed  CAS  Google Scholar 

  19. Gattringer KB, Suchomel M, Eder M et al (2010) Time-dependent effects of rifampicin on staphylococcal biofilms. Int J Artif Organs 33:621–626

    PubMed  CAS  Google Scholar 

  20. Goeau-Brissonniere O, Javerliat I, Koskas F et al (2011) Rifampin-bonded vascular grafts and postoperative infections. Ann Vasc Surg 25:134–142

    Article  PubMed  Google Scholar 

  21. Goeau-Brissonniere OA, Fabre D, Leflon-Guibout V et al (2002) Comparison of the resistance to infection of rifampin-bonded gelatin-sealed and silver/collagen-coated polyester prostheses. J Vasc Surg 35:1260–1263

    PubMed  Google Scholar 

  22. Greenblatt DY, Rajamanickam V, Mell MW (2011) Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg 54:433–439

    Article  PubMed  Google Scholar 

  23. Hardman S, Cope A, Swann A et al (2004) An in vitro model to compare the antimicrobial activity of silver-coated versus rifampicin-soaked vascular grafts. Ann Vasc Surg 18:308–313

    Article  PubMed  CAS  Google Scholar 

  24. Harnoss JC, Partecke LI, Heidecke CD et al (2010) Concentration of bacteria passing through puncture holes in surgical gloves. Am J Infect Control 38:154–158

    Article  PubMed  Google Scholar 

  25. Hernandez-Richter T, Schardey HM, Lohlein F et al (2000) The prevention and treatment of vascular graft infection with a Triclosan (Irgasan)-bonded Dacron graft: an experimental study in the pig. Eur J Vasc Endovasc Surg 20:413–418

    Article  PubMed  CAS  Google Scholar 

  26. Hernandez-Richter T, Schardey HM, Wittmann F et al (2003) Rifampin and Triclosan but not silver is effective in preventing bacterial infection of vascular dacron graft material. Eur J Vasc Endovasc Surg 26:550–557

    Article  PubMed  CAS  Google Scholar 

  27. Hicks RC, Greenhalgh RM (1997) The pathogenesis of vascular graft infection. Eur J Vasc Endovasc Surg 14(Suppl A):5–9

    Article  PubMed  Google Scholar 

  28. Holdsworth J (1999) Treatment of infective and potentially infective complications of vascular bypass grafting using gentamicin with collagen sponge. Ann R Coll Surg Engl 81:166–170

    PubMed  CAS  Google Scholar 

  29. Howe CW, Marston AT (1962) A study on sources of postoperative staphylococcal infection. Surg Gynecol Obstet 115:266–275

    PubMed  CAS  Google Scholar 

  30. Javerliat I, Goeau-Brissonniere O, Sivadon-Tardy V et al (2007) Prevention of staphylococcus aureus graft infection by a new gelatin-sealed vascular graft prebonded with antibiotics. J Vasc Surg 46:1026–1031

    Article  PubMed  Google Scholar 

  31. Jones L, Braithwaite BD, Davies B et al (1997) Mechanism of late prosthetic vascular graft infection. Cardiovasc Surg 5:486–489

    Article  PubMed  CAS  Google Scholar 

  32. Jorgensen LG, Sorensen TS, Lorentzen JE (1991) Clinical and pharmacokinetic evaluation of gentamycin containing collagen in groin wound infections after vascular reconstruction. Eur J Vasc Surg 5:87–91

    Article  PubMed  CAS  Google Scholar 

  33. Knight BC, Tait WF (2009) Dacron patch infection following carotid endarterectomy: a systematic review of the literature. Eur J Vasc Endovasc Surg 37:140–148

    Article  PubMed  CAS  Google Scholar 

  34. Kommission Krankenhaushygiene und Infektionsprophylaxe beim Robert Koch-Institut (2007) Prävention postoperativer Infektionen im Operationsgebiet. Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert-Koch-Institut. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 50:377–393

    Article  Google Scholar 

  35. Koshiko S, Sasajima T, Muraki S et al (2002) Limitations in the use of rifampicin-gelatin grafts against virulent organisms. J Vasc Surg 35:779–785

    Article  PubMed  Google Scholar 

  36. Kramer A, Assadian O, Lademann J (2010) Prevention of postoperative wound infections by covering the surgical field with iodine-impregnated incision drape (Ioban 2). GMS Krankenhhyg Interdiszip 5

  37. Kuehn C, Graf K, Mashaqi B et al (2010) Prevention of early vascular graft infection using regional antibiotic release. J Surg Res 164:185–191

    Article  Google Scholar 

  38. Landsdown AB, Williams A (2007) Bacterial resistance to silver in wound care and medical devices. J Wound Care 16:15–19

    PubMed  CAS  Google Scholar 

  39. Larena-Avellaneda A, Russmann S, Fein M et al (2009) Prophylactic use of the silver-acetate-coated graft in arterial occlusive disease: a retrospective, comparative study. J Vasc Surg 50:790–798

    Article  PubMed  Google Scholar 

  40. Lewis DA, Leaper DJ, Speller DC (1984) Prevention of bacterial colonization of wounds at operation: comparison of iodine-impregnated („Ioban“) drapes with conventional methods. J Hosp Infect 5:431–437

    Article  PubMed  CAS  Google Scholar 

  41. Lorenz U, Schafer T, Ohlsen K et al (2011) In vivo detection of staphylococcus aureus in biofilm on vascular prostheses using non-invasive biophotonic imaging. Eur J Vasc Endovasc Surg 41:68–75

    Article  PubMed  CAS  Google Scholar 

  42. Lovering AM, MacGowan AP (1999) A comparative study of the rifampicin binding and elution characteristics for collagen- and albumin-sealed vascular grafts. Eur J Vasc Endovasc Surg 17:347–350

    Article  PubMed  CAS  Google Scholar 

  43. Lovering AM, White LO, MacGowan AP et al (1996) The elution and binding characteristics of rifampicin for three commercially available protein-sealed vascular grafts. J Antimicrob Chemother 38:599–604

    Article  PubMed  CAS  Google Scholar 

  44. Malassiney P, Goeau-Brissonniere O, Coggia M et al (1996) Rifampicin loading of vascular grafts. J Antimicrob Chemother 37:1121–1129

    Article  PubMed  CAS  Google Scholar 

  45. Manncke K, Heeg P (1984) Experimental and clinical studies of the efficacy of an antimicrobial incision drape. Chirurg 55:515–518

    PubMed  CAS  Google Scholar 

  46. Naylor AR (2002) Regarding „Limitations in the use of rifampicin-gelatin grafts against virulent organisms“. J Vasc Surg 35:823–824

    Article  PubMed  Google Scholar 

  47. Naylor AR (2010) Commentary on ‚‚Microbial spectrum and primary resistance to rifampicin in infectious complications in vascular surgery: limits to the use of rifampicin-bonded prosthetic grafts’’. Angiology 61:421–422

    Article  PubMed  Google Scholar 

  48. O’Connor SA (2004) Re: efficacy of silver in preventing bacterial infection of vascular dacron graft material. Eur J Vasc Endovasc Surg 27:565

    Google Scholar 

  49. Partecke LI, Goerdt AM, Langner I et al (2009) Incidence of microperforation for surgical gloves depends on duration of wear. Infect Control Hosp Epidemiol 30:409–414

    Article  PubMed  Google Scholar 

  50. Pounds LL, Montes-Walters M, Mayhall CG et al (2005) A changing pattern of infection after major vascular reconstructions. Vasc Endovascular Surg 39:511–517

    Article  PubMed  Google Scholar 

  51. Reichel M, Heisig P, Kohlmann T et al (2009) Alcohols for skin antisepsis at clinically relevant skin sites. Antimicrob Agents Chemother 53:4778–4782

    Article  PubMed  CAS  Google Scholar 

  52. Ricco JB (2006) InterGard silver bifurcated graft: features and results of a multicenter clinical study. J Vasc Surg 44:339–346

    Article  PubMed  Google Scholar 

  53. Rutten HJ, Nijhuis PH (1997) Prevention of wound infection in elective colorectal surgery by local application of a gentamicin-containing collagen sponge. Eur J Surg Suppl 578:31–35

    PubMed  Google Scholar 

  54. Sacar M, Goksin I, Baltalarli A et al (2005) The prophylactic efficacy of rifampicin-soaked graft in combination with systemic vancomycin in the prevention of prosthetic vascular graft infection: an experimental study. J Surg Res 129:329–334

    Article  PubMed  CAS  Google Scholar 

  55. Sacar M, Sacar S, Kaleli I et al (2007) Linezolid alone and in combination with rifampicin prevents experimental vascular graft infection due to methicillin-resistant staphylococcus aureus and staphylococcus epidermidis. J Surg Res 139:170–175

    Article  PubMed  CAS  Google Scholar 

  56. Schmacht D, Armstrong P, Johnson B et al (2005) Graft infectivity of rifampin and silver-bonded polyester grafts to MRSA contamination. Vasc Endovascular Surg 39:411–420

    Article  PubMed  Google Scholar 

  57. Schneider F, O’Connor S, Becquemin JP (2008) Efficacy of collagen silver-coated polyester and rifampin-soaked vascular grafts to resist infection from MRSA and Escherichia coli in a dog model. Ann Vasc Surg 22:815–821

    Article  PubMed  Google Scholar 

  58. Stewart A, Eyers PS, Earnshaw JJ (2006) Prevention of infection in arterial reconstruction. Cochrane Database Syst Rev 3:CD003073

    PubMed  CAS  Google Scholar 

  59. Stewart AH, Eyers PS, Earnshaw JJ (2007) Prevention of infection in peripheral arterial reconstruction: a systematic review and meta-analysis. J Vasc Surg 46:148–155

    Article  PubMed  Google Scholar 

  60. Strachan CJ, Newsom SW, Ashton TR (1991) The clinical use of an antibiotic-bonded graft. Eur J Vasc Surg 5:627–632

    Article  PubMed  CAS  Google Scholar 

  61. Topel I, Audebert F, Betz T et al (2010) Microbial spectrum and primary resistance to rifampicin in infectious complications in vascular surgery: limits to the use of rifampicin-bonded prosthetic grafts. Angiology 61:423–426

    Article  PubMed  Google Scholar 

  62. Ueberrueck T, Meyer L, Zippel R et al (2005) Healing characteristics of a new silver-coated, gelatine impregnated vascular prosthesis in the porcine model. Zentralbl Chir 130:71–76

    Article  PubMed  CAS  Google Scholar 

  63. Ueberrueck T, Zippel R, Tautenhahn J et al (2005) Vascular graft infections: in vitro and in vivo investigations of a new vascular graft with long-term protection. J Biomed Mater Res B Appl Biomater 74:601–607

    PubMed  Google Scholar 

  64. Vogel TR, Symons R, Flum DR (2008) The incidence and factors associated with graft infection after aortic aneurysm repair. J Vasc Surg 47:264–269

    Article  PubMed  Google Scholar 

  65. Wacha H, Hoyme U, Isenmann R et al (2010) Empfehlungen einer Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. „Perioperative Antibiotik-Prophylaxe“. J Chemother 19:70–84

    Google Scholar 

  66. Webster J, Alghamdi AA (2007) Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev:CD006353

    Google Scholar 

  67. Webster J, Osborne S (2007) Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev:CD004985

    Google Scholar 

  68. Zdanowski Z, Danielsson G, Jonung T et al (2000) Intraoperative contamination of synthetic vascular grafts. Effect of glove change before graft implantation. A prospective randomised study. Eur J Vasc Endovasc Surg 19:283–287

    Article  PubMed  CAS  Google Scholar 

  69. Zegelman M, Guenther G, Florek HJ et al (2009) Results from the first in man german pilot study of the silver graft, a vascular graft impregnated with metallic silver. Vascular 17:190–196

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sektion Gefäßchirurgie – Endovaskuläre Chirurgie, Klinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland

    R. Kellersmann

  2. Klinisches Institut für Krankenhaushygiene, Medizinische Universität Wien, Wien, Österreich

    O. Assadian

  3. Klinik für Gefäß- und Thoraxchirurgie, Krankenhaus Nordwest, Frankfurt am Main, Deutschland

    M. Zegelman

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  1. R. Kellersmann
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  2. O. Assadian
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Correspondence to R. Kellersmann.

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Kellersmann, R., Assadian, O. & Zegelman, M. Infektionen von Gefäßprothesen. Gefässchirurgie 17, 12–22 (2012). https://doi.org/10.1007/s00772-011-0949-4

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