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

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.

Key words: vascular graft infections, antimicrobial drug treatment, biofilm, antimicrobial resistance, pharmacokinetics, pathogens, debridement, infection control