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Open Access Research article

Intra-abdominal aortic graft infection: prognostic factors associated with in-hospital mortality

Matthias Garot1, Pierre-Yves Delannoy1, Agnès Meybeck1, Béatrice Sarraz-Bournet2, PierVito d’Elia2, Thibaud d’Escrivan3, Patrick Devos4 and Olivier Leroy5*

Author Affiliations

1 Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, Tourcoing 59, France

2 Service de chirurgie vasculaire, Hôpital Chatiliez, Tourcoing 59, France

3 Département d’anesthésie, Hôpital Chatiliez, Tourcoing 59, France

4 Département de bio statistiques, CHRU, Lille 59, France

5 Service de Réanimation Médicale et Maladies Infectieuses, Hôpital Chatiliez, Rue du Président Coty, Tourcoing 59208, France

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BMC Infectious Diseases 2014, 14:215  doi:10.1186/1471-2334-14-215

Published: 22 April 2014

Abstract

Background

Mortality associated with aortic graft infection is considerable. The gold standard for surgical treatment remains explantation of the graft. However, prognostic factors associated with early mortality due to this surgical procedure are not well-known.

Methods

Retrospective analysis of patients admitted in our center between January 2006 and October 2011 for aortic graft infection. The primary endpoint was in-hospital mortality. A bivariate analysis of characteristics of patients associated with in-hospital outcome was performed.

Results

Twenty five evaluable patients were studied. All patients were male. Their mean age was 67 ± 8.4 years. Most of them (92%) had severe underlying diseases. An in situ prosthetic graft replacement, mainly using cryopreserved arterial allografts, was performed in all patients, excepted one who underwent extra-anatomic bypass. Causative organisms were identified in 23 patients (92%). The in-hospital mortality rate was 48%. Among pre-operative characteristics, age ≥ 70 years, creatinine ≥ 12 mg/L and C reactive protein ≥ 50 mg/L were significantly associated with in-hospital mortality. Hospital mortality rates increased with the number of risk factor present on ICU admission, and were 0%, 14.3%, 85.7% and 100% for 0, 1, 2 and 3 factors, respectively. The only intra-operative factor associated with prognosis was an associated intestinal procedure due to aorto-enteric fistula. SAPS II, SOFA score and occurrence of medical or surgical complications were postoperative characteristics associated with in-hospital mortality.

Conclusion

Morbidity and mortality associated with surgical approach of aortic graft infections are considerable. Age and values of creatinine and C Reactive protein on hospital admission appear as the most important determinant of in hospital mortality. They could be taken into account for guiding the surgical strategy.

Keywords:
Aortic graft; Aortic surgery; Prosthetic infection; Prognosis