Diagnosis of prosthetic vascular graft infection using the management aortic graft infection collaboration (MAGIC) criteria

Abstract

Background

Vascular graft infection (VGI) is a devastating complication that necessitates immediate diagnosis to reduce morbidity and mortality. In 2016, The Management of Aortic Graft Infection Collaboration (MAGIC) proposed a diagnostic algorithm for identifying aortic graft infection which uses clinical, radiological, and laboratory findings to determine risk. The purpose of this study was to retrospectively validate the MAGIC criteria for VGI diagnosis and potentially broaden its application.

Methods

An IRB approved retrospective cohort study was performed with 28 suspected VGI patients from our institution. A blinded chart review categorized patients based on MAGIC criteria into “infected,” “suspected infection,” or “insufficient evidence” groups. Due to the MAGIC criteria’s placement of a third outcome, “suspected infection,” the results were dichotomized into two systems whereby “suspected infection” patients were considered as infected (S = I) or uninfected (S = NI). Both dichotomized systems from the MAGIC criteria were then compared to the clinical diagnosis (with surgical evidence when possible) from which sensitivity and specificity were calculated.

Results

A total of 15 patients (54%) presented with definitive VGI, two patients (7%) presented with suspicion for VGI, and 11 patients (39%) presented with insufficient evidence to suspect VGI; placement in these categories were determined by the MAGIC criteria at entry to the study. When using clinical diagnoses, 17 out of 28 had VGI (61%). When using the categorization system S = I, sensitivity was 88.2% and specificity of 100%, for S = NI, sensitivity dropped to 76.4%, but specificity remained at 100%. These results were recomputed using only 25 of the 28 patients who were good surgical candidates. Using this new surgical threshold and smaller cohort to compare MAGIC against, sensitivity was calculated to be 93.3% with a specificity of 100% when S = I. When S = NI, the sensitivity was calculated to be 86.7% with specificity remaining at 100%.

Conclusions

The MAGIC criteria provide excellent specificity and reasonable sensitivity for diagnosis of VGI for peripheral and aortic revascularization.

Keywords

Vascular graft infection peripheral grafts MAGIC PET

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References

Saleem

Meerwaldt

Tielliu

IFJ

, et al. Conservative treatment of vascular prosthetic graft infection is associated with high mortality. Am J Surg 2010; 200(1): 47–52. DOI: 10.1016/j.amjsurg.2009.05.018.

Szczot

Meybeck

Legout

, et al. Vascular graft infections in the intensive care unit: clinical spectrum and prognostic factors. J Infect 2011; 62(3): 204–211. DOI: 10.1016/j.jinf.2010.12.006.

Sohail

Wilson

Baddour

. Infections of nonvalvular cardiovascular devices. In: Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. 8th ed. Philadelphia, PA: Saunders, 2015, pp. 1041–1056.

Gharamti

Kanafani

. Vascular graft infections: an update. Infect Dis Clin 2018; 32(4): 789–809. DOI: 10.1016/j.idc.2018.06.003.

Whitcher

Bertges

Shukla

. Peripheral vascular stent infection: case report and review of literature. Ann Vasc Surg 2018; 51: 326. DOI: 10.1016/j.avsg.2018.02.047.

Kilic

Arnaoutakis

Reifsnyder

, et al. Management of infected vascular grafts. Vasc Med 2016; 21(1): 53–60. DOI: 10.1177/1358863X15612574.

Chakfé

Diener

Lejay

, et al. Editor’s choice – European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections. Eur J Vasc Endovasc Surg 2020; 59(3): 339–384. DOI: 10.1016/j.ejvs.2019.10.016.

Keidar

Nitecki

. FDG-PET in prosthetic graft infections. Semin Nucl Med 2013; 43(5): 396–402. DOI: 10.1053/j.semnuclmed.2013.04.004.

Reinders Folmer

von Meijenfeldt

GCI

te Riet ook genaamd Scholten

, et al. A systematic review and meta-analysis of 18F-fluoro-D-deoxyglucose positron emission tomography interpretation methods in vascular graft and endograft infection. J Vasc Surg 2020; 72(6): 2174–2185. DOI: 10.1016/j.jvs.2020.05.065.

10.

Kim

S-J

Lee

S-W

Jeong

, et al. A systematic review and meta-analysis of ¹⁸F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography for detection of infected prosthetic vascular grafts. J Vasc Surg 2019; 70(1): 307–313. DOI: 10.1016/j.jvs.2019.01.051.

11.

Lauri

Iezzi

Rossi

, et al. Imaging modalities for the diagnosis of vascular graft infections: a consensus paper amongst different specialists. J Clin Med 2020; 9(5): 1510. DOI: 10.3390/jcm9051510.

12.

Jamar

Buscombe

Chiti

, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med 2013; 54(4): 647–658. DOI: 10.2967/jnumed.112.112524.

13.

Bruggink

Glaudemans

Saleem

, et al. Accuracy of FDG-PET-CT in the diagnostic work-up of vascular prosthetic graft infection. Eur J Vasc Endovasc Surg 2010; 40(3): 348–354. DOI: 10.1016/j.ejvs.2010.05.016.

14.

Keidar

Engel

Hoffman

, et al. Prosthetic vascular graft infection: the role of 18F-FDG PET/CT. J Nucl Med 2007; 48(8): 1230–1236. DOI: 10.2967/jnumed.107.040253.

15.

Rojoa

Kontopodis

Antoniou

, et al. 18F-FDG PET in the diagnosis of vascular prosthetic graft infection: a diagnostic test accuracy meta-analysis. Eur J Vasc Endovasc Surg 2019; 57(2): 292–301. DOI: 10.1016/j.ejvs.2018.08.040.

16.

Lyons

OTA

Baguneid

Barwick

, et al. Diagnosis of aortic graft infection: a case definition by the management of aortic graft infection collaboration (MAGIC). Eur J Vasc Endovasc Surg 2016; 52(6): 758–763. DOI: 10.1016/j.ejvs.2016.09.007.

17.

Gross

DeMauro

Van Antwerpen

, et al. Number of comorbidities as a predictor of nosocomial infection acquisition. Infect Control Hosp Epidemiol 1988; 9(11): 497–500. DOI: 10.1086/645759.

18.

Anagnostopoulos

Ledergerber

Kuster

VASGRA Cohort Study , et al.. Inadequate perioperative prophylaxis and postsurgical complications after graft implantation are important risk factors for subsequent vascular graft infections: prospective results from the vascular graft infection cohort study. Clin Infect Dis 2019; 69(4): 621–630. DOI: 10.1093/cid/ciy956.

19.

Anagnostopoulos

Mayer

Ledergerber

, et al. Editor’s choice – validation of the management of aortic graft infection collaboration (MAGIC) criteria for the diagnosis of vascular graft/endograft infection: results from the prospective vascular graft cohort study. Eur J Vasc Endovasc Surg 2021; 62(2): 251–257. DOI: 10.1016/j.ejvs.2021.05.010.

20.

Reinders Folmer

Von Meijenfeldt

GCI

Van der Laan

, et al. Diagnostic imaging in vascular graft infection: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2018; 56(5): 719–729. DOI: 10.1016/j.ejvs.2018.07.010.