Document Detail


Significance of infection markers and microbiological findings during tissue processing of cryopreserved arterial homografts for the early postoperative course.
MedLine Citation:
PMID:  19998257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To evaluate homograft implantation for the urgent treatment of vascular infections on the basis of the course of infection using microbiological findings in perioperatively obtained specimens and during homograft processing.
PATIENTS AND METHODS: 85 patients were treated with cryopreserved homografts from 2004-2007. The microbiological findings of the decontamination process of homografts in the tissue bank were evaluated. The perioperative infection profile (microorganisms, CRP, leukocytes, body temperature) of the patients was analysed.
RESULTS: Complete microbiological and clinical follow-up for the postoperative course was available for 35 patients, who were treated with homografts from the same tissue bank and finally included into this study. 55 cryopreserved homografts were implanted. 35/55 (64%) homografts were positive for microorganisms before decontamination. 3/35 (9%) homografts remained positive after the decontamination. 33 patients were operated for prosthetic graft infection and 2 for an infiltration of a large vessel from neighbouring malignant disease. The most common infection agent was Staphylococcus aureus. Thirty-day mortality was 20% (7/35). Only in 4/35 (11%) patients were the microorganisms of the intraoperative swabs also detected during the postoperative course. The microorganisms were ORSA, Enterococcus faecium, Enterobacter aerogenes and Burkholderia cepacia. The patient with ORSA infection died on POD 11 from multiple organ failure and all other patients recovered. None of the postoperative swabs showed the homograft predecontamination microorganisms. Interestingly, a significant association (P = 0.003) between C-reactive protein increase two weeks after surgery and donor-recipient ABO mismatch was found.
CONCLUSIONS: The implantation of homografts following the established decontamination is an alternative urgent therapeutic option in vascular infections with encouraging outcomes. The absence of the predecontamination focus in the postoperative specimens of patients, suggests that the postoperative course and outcomes show no strong relation to potential homograft contamination prior to the decontamination process.
Authors:
T E Bisdas; F Mattner; E Ott; M A Pichlmaier; M Wilhelmi; A Haverich; O Teebken
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  VASA. Zeitschrift für Gefässkrankheiten     Volume:  38     ISSN:  0301-1526     ISO Abbreviation:  VASA     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-12-09     Completed Date:  2010-02-04     Revised Date:  2012-10-19    
Medline Journal Info:
Nlm Unique ID:  0317051     Medline TA:  Vasa     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  365-73     Citation Subset:  IM    
Affiliation:
Hannover Medical School, Dept. of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover, Germany.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aneurysm, Infected / microbiology,  mortality,  surgery*
Aneurysm, Ruptured / microbiology,  mortality,  surgery*
Arteries / microbiology,  transplantation*
Blood Grouping and Crossmatching
Blood Vessel Prosthesis / adverse effects*
Cryopreservation*
Decontamination*
Female
Graft Survival
Heart Valve Prosthesis / adverse effects*
Hospital Mortality
Humans
Iliac Artery / microbiology,  pathology,  surgery
Male
Middle Aged
Neoplasm Invasiveness
Prosthesis-Related Infections / microbiology,  mortality,  surgery*
Pulmonary Artery / microbiology,  pathology,  surgery
Reoperation
Time Factors
Tissue and Organ Harvesting*
Transplantation, Homologous
Treatment Outcome

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