Vascular Graft Infections Updates on a Challenging Problem

Vascular graft infection (VGI) is a rare but serious complication of vascular surgery. It leads to high mortality and is associated with a great financial burden. VGI occurs due to gram-positive organisms in up to half of the cases, with coagulase-negative staphylococci being the most common. Other organisms implicated in the microbiology of VGI include gram-negative rods and Candida spp. Vascular grafts are classified as extra cavitary and intracavitary, with the latter being associated with higher mortality rates that can reach up to 80%. We can also classify VGI based on timing, whether it's early or late, occurring within 4 months of surgery or after, respectively. Risk factors for VGI include patient-specific and procedure-specific risk factors, and preventative measures aim to target these risk factors to minimize infections post vascular surgeries. Diagnosis is based on clinical, radiologic, or laboratory characteristics within specific criteria established as the MAGIC criteria. Management of VGI comprises a multidisciplinary approach and includes both surgical and antimicrobial treatments. Empiric antibiotics require broad-spectrum gram-positive and gram-negative coverage preferably covering methicillin-resistant S aureus and Pseudomonas. The addition of rifampin was also found to be associated with a lower risk of treatment failure. Surgical treatment options include either EAB or iISR. There is still a question regarding the optimal duration of treatment for VGI, and it can range from 2 weeks to lifelong suppressive therapy depending on whether the patient underwent surgery or not.