中国实用外科杂志2024，Vol.44Issue(12)：1358-1362,5.DOI:10.19538/j.cjps.issn1005-2208.2024.12.08
血管移植物感染抗微生物药物治疗策略及合理选择
Treatment strategies and reasonable selection of antimicrobial drugs for vascular graft infections
摘要
Abstract
Vascular graft infection(VGI)is a rare but severe complication following vascular graft surgery.Its risk factors are associated with graft location,material,type,and resistance of pathogenic microorganisms,as well as the patient's age and comorbidities.The primary pathogens include Gram-positive bacteria such as coagulase-negative staphylococci,Staphylococcus aureus,and enterococci,as well as Gram-negative bacteria,anaerobes,and fungi.The diagnosis and management of VGI rely on timely pathogen identification through sampling,followed by effective antimicrobial therapy and surgical intervention.Antimicrobial therapy is central to VGI management,requiring consideration of pathogen type,infection site,patient's baseline characteristics,and the biofilm-penetration properties of the drugs.Empirical therapy generally includes broad-spectrum coverage of Gram-positive and Gram-negative bacteria,using biofilm-penetrating agents.Targeted therapy,guided by pathogen identification,involves the use of narrow-spectrum agents such as penicillin,vancomycin,and rifampin.For resistant strains,such as extended-spectrum beta-lactamase-producing Enterobacterales or carbapenem-resistant bacteria,carbapenems or new β-lactamase inhibitor compounds can be used.In biofilm-associated infections,rifampin or fluoroquinolones can be combined to enhance efficacy.Therapeutic regimens guided by pharmacokinetic/pharmacodynamic(PK/PD)principles can optimize antimicrobial efficacy,with drug selection tailored to concentration-or time-dependent properties according to the relationship between drug concentration and time.The duration of antimicrobial therapy depends on the severity of infection,pathogen characteristics,and clinical follow-up outcomes,typically lasting 4-6 weeks,with extensions to 3-6 months or even lifelong treatment when necessary.Complete debridement and graft replacement are critical for improving VGI outcomes.In cases where complete eradication of infection is not feasible,long-term antimicrobial therapy is recommended,with regular monitoring for efficacy and adverse effects.Timely and adequate antimicrobial therapy combined with precise surgical intervention can significantly reduce VGI-associated mortality and extend infection-free survival.关键词
血管移植物感染/抗微生物药物治疗/生物膜/抗微生物药物耐药性/药代动力学/病原体/清创术/感染控制Key words
vascular graft infections/antimicrobial drug treatment/biofilm/antimicrobial resistance/pharmacokinetics/pathogens/debridement/infection control分类
医药卫生引用本文复制引用
陈璋璋,陈灿,岳嘉宁,吕迁洲,李晓宇..血管移植物感染抗微生物药物治疗策略及合理选择[J].中国实用外科杂志,2024,44(12):1358-1362,5.基金项目
上海市卫生健康委员会临床研究专项(No.202240293) （No.202240293）
上海市医院协会抗菌药物科学化标杆管理项目(No.2023LCYS001_S02) （No.2023LCYS001_S02）
