Infected arterial grafts: experince in 22 cases with empsis on unusual bactia and technics.
About: This article is published in Annals of Surgery.The article was published on 1970-05-01 and is currently open access. It has received 85 citations till now.
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TL;DR: Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others.
Abstract: Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.
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...Other sources include burn wounds, peripartum mothers and infants, bone, and intravascular catheters (45, 80, 129, 130, 193)....
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709 citations
TL;DR: The clinical manifestations and results of management in patients treated for infected vascular prostheses are reviewed and the over-all incidence of infection in this series of prosthetic grafts is 2.5 per cent; however, grafts inserted between 1966 and 1973 have an infection rate of 1.5per cent.
Abstract: The clinical manifestations and results of management in twenty-seven patients treated for infected vascular prostheses are reviewed The mortality of 37 per cent and a loss of limb rate of 37 per cent are testimony to the serious nature of the problem The over-all incidence of infection in our series of prosthetic grafts is 25 per cent; however, grafts inserted between 1966 and 1973 have an infection rate of 15 per cent as compared to that of grafts inserted prior to 1966 when the infection rate was 41 per cent The most likely explanation for this lowered rate of infection was a corresponding change in prophylactic antibiotic management
290 citations
TL;DR: The prospects for cure as reported in this series justify an aggressive operative approach and a successful outcome following definitive treatment of these devastating complications is possible for the majority of affected patients.
172 citations
TL;DR: Large-diameter arterial SIS grafts are more resistant to persistent infection with S. aureus than ePTFE grafts in this dog model of deliberate bacterial inoculation.
165 citations