Open Access Research article

Factors predictive of treatment failure in staphylococcal prosthetic vascular graft infections: a prospective observational cohort study: impact of rifampin

Laurence Legout1*, Piervito Delia34, Béatrice Sarraz-Bournet3, Cécile Rouyer1, Massongo Massongo1, Michel Valette1, Olivier Leroy2, Stephan Haulon4 and Eric Senneville1

Author Affiliations

1 Infectious Diseases Department, Dron Hospital of Tourcoing, Rue du Président Coty, Tourcoing 59208, France

2 Intensive Care and Infectious Diseases Unit, Dron Hospital of Tourcoing, Tourcoing, France

3 Department of Vascular Surgery, Dron Hospital of Tourcoing, Tourcoing, France

4 Department of Vascular Surgery, University Hospital of Lille, Lille, France

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BMC Infectious Diseases 2014, 14:228  doi:10.1186/1471-2334-14-228

Published: 28 April 2014

Abstract

Background

There exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).

Methods

All data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.

Results

84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].

Conclusion

Results of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.

Keywords:
Vascular graft infection; Prosthesis infection; Staphylococci; Rifampin