TOPLINE:

Suppressive antimicrobial therapy (SAT) was a viable and effective option for patients with prosthetic vascular graft infection (PVGI) who were at a high surgical risk. PET-CT played a key role in diagnosis and monitoring.

METHODOLOGY:

• Researchers conducted a retrospective observational study at a tertiary care centre in Rome between January 2014 and February 2025 to evaluate the efficacy of SAT in patients with PVGI.
• A total of 25 patients (median age, 72 years; 84% men) who met the Management of Aortic Graft Infection Collaboration criteria for PVGI (including traditional and endovascular grafts) were included, with the infection diagnosed at a median of 90 days post-surgery.
• The primary outcome was the efficacy of SAT, defined as infection control during treatment, with resolution of clinical signs and radiologic improvement or stability; patient condition was categorised as improved if symptom resolution and radiologic resolution or stability were achieved or as treatment failure if clinical and/or radiologic progression requiring therapy modification was reported.
• The secondary outcomes were the tolerability of SAT (ie, absence of adverse drug events that necessitated a change in therapy) and cure of PVGI (ie, absence of relapses during at least 6 months of follow-up after discontinuation of SAT).

TAKEAWAY:

• At least one causative pathogen was identified in 68% of patients, with microbiologic diagnosis more frequently achieved in those with early infection (P = .03).
• Treatment was ongoing for 10 patients at the time of study publication, and their condition improved while on SAT. Among another 10 patients who discontinued SAT, six remained relapse-free after a median follow-up duration of 12 months, whereas four experienced relapse, of whom two resumed therapy and two died from unrelated causes.
• Ten adverse events were reported in eight patients, of whom five required a change in the SAT regimen. Patients who received trimethoprim-sulfamethoxazole had the highest rate of adverse effects at 30%, with renal toxicity observed in three patients.
• Treatment failure occurred in 11 patients, and those who received amoxicillin-clavulanate had the highest rate of treatment failure at 73%.

IN PRACTICE:

"Finally, a multidisciplinary approach should always be adopted — encompassing specialists in infectious diseases, surgery, microbiology, radiology, nuclear medicine, and, where possible, clinical pharmacology — to establish expert consensus and to optimize the use of new therapeutic strategies," the authors wrote.

SOURCE:

The study was led by Alessandra Imeneo, MD, University of Tor Vergata in Rome, Italy. It was published online on June 05, 2026, in Open Forum Infectious Diseases.

LIMITATIONS:

The study was limited by its retrospective and single-centre design, small cohort, and the heterogeneity of surgical interventions, which limited the generalisability of the results. Treatment failure rates may have been overestimated due to assessment bias. Long-acting antibiotics were administered without standardised dosing, and therapeutic drug monitoring was not performed; relapses could not be reliably differentiated from reinfection in the absence of microbiologic data.

DISCLOSURES:

The study did not receive any external funding. One author disclosed serving on the advisory board for BD Biosciences; a few others disclosed receiving honoraria, research grants, and fees for lectures and expertise from various institutions and pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.