Vascular Graft Infections Treated With Bioabsorbable Antibiotic Beads

Introduction: Inguinal vascular surgical site infections (VSSI) and infected prosthetic grafts remain a critical problem in vascular surgery. Prior clinical reports suggest antibiotic-impregnated beads may be used to attempt salvage of the graft and improve outcomes, especially if explant would result in major amputation or mortality. Described is our institutional experience managing inguinal VSSI using bioabsorbable, antibiotic-impregnated beads compared to inguinal VSSI managed with debridement alone.

Methods: Patients with VSSIs after lower-extremity procedures were identified through the institutional database and departmental registries from 2014 to 2023. Cases were excluded if they did not involve an inguinal wound infection or an operation for VSSI management. Outcomes, including amputation-free survival, reinfection, and re-operation for infection were recorded, along with microbial isolates. Basic descriptive statistics, Kaplan-Meier, and Multiple variable Cox proportional hazards analyses were performed.

Results: There were 43 patients identified (23 with intravenous antibiotics and debridement alone, and 20 treated with intravenous antibiotics, debridement, and antibiotic beads). The two groups differed significantly in their Szilagyi classification, with thirteen patients (65%) with class III infections in the antibiotic bead group compared with one (7%) in the debridement alone group. There was no significant difference in amputation-free survival for those cases that received debridement and antibiotic beads versus debridement alone (P = 0.20) or amputation-free survival between Szilagyi classifications (P = 0.47) despite a higher representation of Szilagyi III cases in the antibiotic bead group (P = 0.0001). Patients with graft infections treated with beads experienced similar survival outcomes to patients with subcutaneous infections treated with debridement alone (P = 0.21).

Conclusions: The efficacy of bioabsorbable antibiotic beads in VSSIs remains controversial. While this cohort study demonstrated an increased risk of re-infection, this is confounded by the antibiotic bead group having a higher frequency of graft infections. Antibiotic beads appear to be safe for use in patients with vascular graft infections and may help achieve outcomes comparable to patients without graft involvement. Further studies with larger patient populations and similar infection severity between groups are needed.