[Clinical characteristics, intervention outcomes and influencing factors for abandonment of infected arteriovenous grafts].

Abstract

Objective: To evaluate the clinical characteristics, intervention outcomes, and influencing factors for abandonment of infected arteriovenous grafts (AVG). Methods: The data of patients who underwent upper-limb AVG placement at the Blood Purification Center, the First Affiliated Hospital of Zhengzhou University between January 2018 and December 2023 were retrospectively analyzed. Incidence, clinical manifestations, and intervention outcomes of infected AVG were analyzed. Influencing factors associated with post-infection AVG abandonment were identified by multivariate logistic regression analysis. Results: During a median follow-up of 755 (IQR: 494-1 158) days, 704 patients with upper limb AVG were included. There were 37 functional AVG infection episodes documented in 37 distinct patients (14 males and 23 females), with a mean age of (58.2±11.2) years. The cumulative incidence of AVG infection was 5.3% (37/704), with an incidence density of 2.25 episodes per 100 patient-years. Infection rates at 3, 6, and 12 months post-AVG placement were 0.6% (4/704), 1.1% (8/704), and 2.3% (16/704), respectively. Local graft inflammation was observed in 97.3% (36/37) of cases, and 64.9% (24/37) of patients presented with systemic symptoms. Microbial cultures were performed in 35 patients, yielding positive rates of 84.2% (16/19) for blood cultures and 78.1% (25/32) for tissue/secretions cultures, with Staphylococcus aureus being the most prevalent pathogen [75.0%(12/16)/57.1%(16/28)]. All patients received antimicrobial therapy, with 75.7% (28/37) treated with vancomycin or linezolid. After infection, the AVG was directly abandoned in 18 cases, eight patients underwent conservative management, and 11 received graft interposition. Functional AVG preservation without recurrence within 90 days was achieved in 15 patients. Multivariate logistic analysis identified that female sex (OR=23.065, 95%CI: 1.867-284.878, P=0.014) and the use of early-cannulation arteriovenous grafts (ACUSEAL) (OR=21.097, 95%CI: 1.674-265.831, P=0.018) were risk factors for graft abandonment post-infection. Conclusions: The overall incidence of AVG infection is relatively low, and functional graft preservation can be achieved through active interventions in appropriately selected cases. Female sex and ACUSEAL are associated with increased risk of post-infection graft abandonment.