ABSTRACT
OBJECTIVE: To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion. BACKGROUND: Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections. Does supplemental anti-MRSA prophylactic coverage provide a significant reduction in Gram-positive or MRSA infections? METHODS: Single center prospective double blinded randomized study of patients undergoing lower extremity vascular procedures from 2011 to 2014. One hundred seventy-eight (178) patients were evaluated at 90 days for surgical site infection. Infections were categorized as early infections less than 30 days of the index procedure and late after 90 days. RESULTS: Early vascular surgical site infection occurred in 7(8.24%) of patients in the Vancomycin arm, and 11 (11.83%) in the Daptomycin arm (P = 0.43). Gram-positive related infections and MRSA infections occurred in 1(1.18%)/0(0%) of Vancomycin patients and 9 (9.68%)/1 (1.08%) of Daptomycin patients, respectively (P < 0.02 and P = 1.00). Readmissions related to surgical site infections occurred in 4(4.71%) in the Vancomycin group and 11 (11.8%) in the Daptomycin group (P = 0.11). Patients undergoing operative exploration occurred in 5 (5.88%) in the Vancomycin group and 10 (10.75%) of the Daptomycin group (P = 0.17). Late infections were reported in 3 patients, 2 of which were in the combined Daptomycin group. Median hospital charges related to readmissions due to a surgical site infection was $50,823 in the combination Vancomycin arm and $110,920 in the combination Daptomycin group; however, no statistical significance was appreciated (P = 0.11). CONCLUSIONS: Vancomycin supplemental prophylaxis seems to reduce the incidence of Gram-positive infection compared with adding supplemental Daptomycin prophylaxis. The Incidence of MRSA-related surgical site infections is low with the addition of either anti-MRSA agents compared with historical incidence of MRSA-related infection.
Subject(s)
Antibiotic Prophylaxis/methods , Methicillin-Resistant Staphylococcus aureus/drug effects , Peripheral Vascular Diseases/drug therapy , Staphylococcal Infections/prevention & control , Surgical Wound Infection/prevention & control , Vascular Surgical Procedures/methods , Adult , Aged , Cefazolin/administration & dosage , Chi-Square Distribution , Daptomycin/administration & dosage , Double-Blind Method , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Lower Extremity , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Middle Aged , Patient Safety , Peripheral Vascular Diseases/diagnostic imaging , Peripheral Vascular Diseases/surgery , Preoperative Care/methods , Prospective Studies , Radiography , Risk Assessment , Treatment Outcome , Vancomycin/administration & dosage , Vascular Surgical Procedures/adverse effectsABSTRACT
Atherosclerosis of the brachiocephalic vessels is uncommon in comparison to the prevalence of disease in the extracranial carotid arteries. Prior to 1980, occlusive disease of this vascular bed had been treated primarily with surgical intervention, which carried a significant rate of morbidity and mortality. In the last 30 years, however, minimally invasive endovascular techniques have become an important tool in the management of symptomatic patients. Angioplasty and stenting have been reported as a viable therapeutic option, producing good technical success and durability. Here, we examine the natural history of subclavian artery occlusive disease, along with the diagnostic evaluation and various treatment modalities currently available, with special attention paid to the evolution of the role of endovascular management.