Determinants of Cure and Survival in Vascular Graft and Endograft Infections: A 13-Year Single-Centre Cohort Study

Abstract

[Abstract] Objectives: To describe clinical and microbiological features, management, and long-term outcomes of vascular graft and endograft infections (VGEIs), and identify factors associated with mortality.

Methods: Retrospective analysis of a single-centre cohort of patients with definite VGEI (2010-2023). Prognostic factors were assessed using Cox and Fine-Gray regression models.

Results: The study included 171 patients; median age was 71 years (interquartile range: 64.0-77.5 years), and 145 of 171 (84.8%) were male. Most infections involved extracavitary grafts (134 of 171, 78.4%). Microbiological samples were positive in 158 of 168 (94.0%) patients, and polymicrobial infection was documented in 69 of 168 (41.1%) patients. Staphylococcus aureus was the most frequent pathogen, although anatomical location strongly influenced clinical and microbiological profiles. Outpatient antimicrobial therapy was completed by 96 of 167 patients (57.5%), primarily through oral administration. Median follow-up was 36 months (interquartile range: 10-78 months). Cumulative mortality was 25.7% (44 of 171) at 1 year and 41.5% (71 of 171) at 3 years. Older age (hazard ratio [HR]: 1.04 per year, 95% CI: 1.01-1.07), higher C-reactive protein (HR: 1.05 per mg/dL, 95% CI: 1.02-1.08), and polymicrobial infection (HR: 2.22, 95% CI 1.30-3.79) independently predicted all-cause mortality. Higher C-reactive protein (subdistribution HR: 1.08, 95% CI: 1.04-1.13) and polymicrobial infection (subdistribution HR: 3.41, 95% CI: 1.15-10.10) were also risk factors of infection-related mortality. Compared with complete graft removal, both partial excision (OR: 0.02, 95% CI: 0.01-0.09) and graft preservation (OR: 0.09, 95% CI: 0.02-0.37) were independently associated with a lower likelihood of clinical cure.

Conclusions: VGEI remains a severe condition with poor long-term outcomes. Adverse prognosis was associated with a high baseline inflammatory burden and polymicrobial aetiology. Surgical and outpatient antimicrobial strategies were associated with favourable outcomes, although these findings should be interpreted cautiously given the observational nature of the study.