Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application
Introduction: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. Report: A 67 year old woman was admitted...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | EJVES Vascular Forum |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666688X22000193 |
| _version_ | 1797990667742347264 |
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| author | Eberhard Grambow Simon Junghans Jens Christian Kröger Emil Christian Reisinger Bernd Joachim Krause Justus Groß |
| author_facet | Eberhard Grambow Simon Junghans Jens Christian Kröger Emil Christian Reisinger Bernd Joachim Krause Justus Groß |
| author_sort | Eberhard Grambow |
| collection | DOAJ |
| description | Introduction: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. Report: A 67 year old woman was admitted with a methicillin sensitive Staphylococcus aureus infected stent graft in the thoracic aorta. Local infection was confirmed by PET-CT imaging. Surgical resection of the stent graft was not feasible because of comorbidities. Therefore, a three step approach for local bacteriophage treatment was performed as a last resort treatment. Firstly, the para-aortic tissue was debrided via left thoracotomy, a bacteriophage suspension was applied on the outer surface of the aorta, and a vacuum irrigation system was installed. After repeated alternating instillation of the bacteriophage suspension for three days, as a second step, the vacuum sponges were removed and a bacteriophage containing gel was applied locally on the outer surface of the aorta. In the third step, the bacteriophage containing gel was applied to a thoracic stent graft, which in turn was placed endovascularly into the infected stent. Discussion: After 28 days, the patient was discharged from hospital with normalised infection parameters. PET-CT imaging at three and 12 months post-intervention did not show signs of infection in or around the thoracic aorta. This Case demonstrates successful treatment of an infected endovascular stent graft by application of bacteriophages both to extravascular and, as a novel approach, endovascular sites using a bacteriophage coated stent graft. |
| first_indexed | 2024-04-11T08:40:08Z |
| format | Article |
| id | doaj.art-adbf76ad28c3425e9fb8094e818826a5 |
| institution | Directory Open Access Journal |
| issn | 2666-688X |
| language | English |
| last_indexed | 2024-04-11T08:40:08Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EJVES Vascular Forum |
| spelling | doaj.art-adbf76ad28c3425e9fb8094e818826a52022-12-22T04:34:14ZengElsevierEJVES Vascular Forum2666-688X2022-01-01562023Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage ApplicationEberhard Grambow0Simon Junghans1Jens Christian Kröger2Emil Christian Reisinger3Bernd Joachim Krause4Justus Groß5Department for General, Visceral-, Thoracic-, Vascular- and Transplantation Surgery, Rostock University Medical Centre, Rostock, Germany; Corresponding author. Department for General, Visceral-, Vascular- and Transplantation Surgery, University Medical Centre Rostock, Schillingallee 35, 18057 Rostock, Germany.G. Pohl-Boskamp GmbH & Co. KG, Hohenlockstedt, GermanyDepartment of Diagnostic, Interventional, Neuro- and Paediatric Radiology, Rostock University Medical Centre, Rostock, GermanyDivision of Tropical Medicine and Infectious Diseases, Centre of Internal Medicine II, University Medical Centre Rostock, Rostock, GermanyDepartment of Nuclear Medicine, Rostock University Medical Centre, Rostock, GermanyDepartment for General, Visceral-, Thoracic-, Vascular- and Transplantation Surgery, Rostock University Medical Centre, Rostock, GermanyIntroduction: Graft infections are severe complications. Surgical resection of infected aortic stent grafts is associated with high mortality and morbidity. Therefore, alternatives or adjuncts to antibiotic treatment and extensive surgery are urgently needed. Report: A 67 year old woman was admitted with a methicillin sensitive Staphylococcus aureus infected stent graft in the thoracic aorta. Local infection was confirmed by PET-CT imaging. Surgical resection of the stent graft was not feasible because of comorbidities. Therefore, a three step approach for local bacteriophage treatment was performed as a last resort treatment. Firstly, the para-aortic tissue was debrided via left thoracotomy, a bacteriophage suspension was applied on the outer surface of the aorta, and a vacuum irrigation system was installed. After repeated alternating instillation of the bacteriophage suspension for three days, as a second step, the vacuum sponges were removed and a bacteriophage containing gel was applied locally on the outer surface of the aorta. In the third step, the bacteriophage containing gel was applied to a thoracic stent graft, which in turn was placed endovascularly into the infected stent. Discussion: After 28 days, the patient was discharged from hospital with normalised infection parameters. PET-CT imaging at three and 12 months post-intervention did not show signs of infection in or around the thoracic aorta. This Case demonstrates successful treatment of an infected endovascular stent graft by application of bacteriophages both to extravascular and, as a novel approach, endovascular sites using a bacteriophage coated stent graft.http://www.sciencedirect.com/science/article/pii/S2666688X22000193Antibiotic resistanceGraft infectionPhage therapyStaphylococcus aureus sepsis |
| spellingShingle | Eberhard Grambow Simon Junghans Jens Christian Kröger Emil Christian Reisinger Bernd Joachim Krause Justus Groß Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application EJVES Vascular Forum Antibiotic resistance Graft infection Phage therapy Staphylococcus aureus sepsis |
| title | Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application |
| title_full | Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application |
| title_fullStr | Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application |
| title_full_unstemmed | Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application |
| title_short | Treatment of an Infected TEVAR with Extra- and Endovascular Bacteriophage Application |
| title_sort | treatment of an infected tevar with extra and endovascular bacteriophage application |
| topic | Antibiotic resistance Graft infection Phage therapy Staphylococcus aureus sepsis |
| url | http://www.sciencedirect.com/science/article/pii/S2666688X22000193 |
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