PDF(Pubmed)
Abstract：
Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray\'s test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.
摘要：
背景和目的：本研究旨在调查动静脉移植物（AVGs）的铜绿假单胞菌（PA）感染在翻修治疗后是否比其他细菌感染更频繁地复发。材料和方法：操作程序，包括完全切除,小计切除，和修订，对60例患者进行治疗65例AVG感染。最终结果分类为无感染复发，感染复发，和没有复发的死亡。在竞争的风险环境中，使用累积发生率函数和灰色检验估计累积发生率，结果与不同变量之间的关联使用子分布风险(SDH)模型进行估计.结果：比较AVG感染有无复发，PA感染与较高的感染复发风险无关（p=0.13）；然而，第一种手术方式与感染复发相关(p=0.04)。与无PA感染的AVG相比，有PA感染的AVG与更高的手术干预总数相关（p<0.05）。关于结果的累积发生率，对于经小计切除或翻修治疗的AVG，首次手术后,有PA感染的患者复发感染的累积发生率比无PA感染患者高3.3倍.然而,当AVG单独进行翻修治疗时，累积发生率为4.1倍.排除全切除治疗的AVG后，应用了SDH模型，与无PA感染的AVG相比，有PA感染的AVG的感染复发风险比为16.05（p=0.02）。没有其他变量与感染复发显着相关。结论：对于次全切除和翻修，感染PA的AVG的复发率高于感染其他物种的AVG。然而,翻修手术可能加重复发率。
