The aim of the present study was to describe the characteristics and prognosis of patients admitted for a PVGI and to assess the factors associated with the death of these patients.
All consecutive patients admitted in our department between January 1, 2000 and January 1, 2018 for a PVGI were enrolled in the present prospective cohort study. PVGIs were divided into extracavitary (femoro-femoral, femoro-popliteal and axillo-femoral) and cavitary (aorto-iliac, aorto-femoral, ilio-femoral, aortic); into “early” infection (<4 months) and late. Patients’ baseline characteristics and their follow-up were described, and factors associated with death were assessed by using a logistic multivariate regression model.
Results: Overall, 200 patients were included during this period. The median age of patients was 69 years [IQR: 61-78], mainly of men (86%). One hundred and sixteen patients had an intracavitary PVGI (58%). Enterobacteriaceae and MSSA were the most frequent pathogens (n=60 and 59), followed by coagulase negative staphylococci (n=30), Streptococcus (n=26) and enterococcus (n=25). Surgery with replacement of the infected prosthesis was performed in 102 patients (53%). Culture of material samples taken during surgery were plurimicrobial in 67 patients (34%). After surgery, the median follow-up of patients was 7.5 months [IQR: 2-19] during which 30 presented a failure (15%) and 85 patients died, 41 due to the PVGI (21%). Factors independently associated with death in multivariate analysis were: to be over 70 years old (OR=8.2; p<0.01), to stay in ICU for more than 6 days (OR=5.9; p=0.01) and to have an intracavitary PVGI (OR=9.0; p=0.02). Antibiotic therapy regimen combining rifampicin to another antibiotic was associated with a decreased mortality (OR=0.11; p<0.01).
Our results suggest that the prognostic of patients admitted for PVGI depends on the site of infection and the occurrence of a shock after the admission. We found a better prognosis for patients with an extracavitary PVGI, without sepsis. Finally, PVGI treated with an antibiotic combination including rifampicin had a better outcome.
M. Valette, None
P. V. D'Elia, None
S. Vandamme, None
O. Leroy, None
B. Lafon-Desmurs, None
E. Senneville, None