g., piperacilline tazobactam) with or without aminoglycosides as first-line empiric antibiotic treatment in patients who had suspected or definite PVGI immediately after intraoperative samples were taken, or as second-line treatment in those who experienced adverse effects with a prior antibiotic regimen. To treat infection and to maintain or re-establish vascular flow to the distal bed, optimal surgical treatment

included complete debridement of devitalized and infected tissues around the prosthesis, total graft excision, and in situ reconstruction with a new prosthesis, autogenous vein, or arterial allograft/homograft. Debridement without graft excision was proposed to patients with very early PVGI or to patients with severe comorbidities. Finally, when revascularization was not possible, amputation was proposed to the patient. Patients were evaluated see more at the end of DAP therapy and at the end of culture-guided therapy; in the case of prosthetic or homograft, they were followed up for 1 year after the end of treatment and, in case of

venous graft, for 3 months after the end of treatment. Clinical success was defined by resolution of all clinical signs at the end of follow-up, with no need for additional antibiotic therapy, and/or negative culture in case of new surgery. Failure was defined as any other outcome. The safety of DAP was PF-01367338 cost assessed on renal function and creatine phosphokinase (CPK) blood levels during treatment. For statistical analysis, numerical data are presented as mean (SD) or median and range. Categorical data are presented as number and percentage. Statistical analysis was performed using Stata® (version 9; StataCorp LP, College Station, TX, USA). Results

Among the 128 patients with suspected or definite PVGI from January 2008 to December 2010 at our two referral centers, 30 (23.4%) were treated with DAP doses >8 mg/kg per day in association with broad-spectrum beta-lactams for PVGI and gave their written consent for treatment. Four patients were excluded because of missing data or suspected PVGIon follow-up. Finally, 26 patients were included in our study. Patient demographic and clinical CYTH4 characteristics are listed in Table 1. Most of patients had intracavitary PVGI (69.2%). Half of the patients had early post-operative PVGI. Radiological signs included false aneurysm (n = 1), disruption of PVGI (n = 3), selleck chemicals thrombosis (n = 2), and periprosthetic collection (n = 24). Microbiological documentation was obtained in 21 patients (80.1%) despite previous antibiotic administration (n = 16) within the 2 days prior to DAP treatment: penicillin (n = 12), carbapenems (n = 1), glycopeptides (n = 6), fluoroquinolones (n = 4), glycylcyclines (n = 1), aminoglycosides (n = 2), or miscellaneous agents (n = 3). Cultures of intraoperative samples were positive in 21 patients (80.1%). Blood and intraoperative cultures were concomitantly positive in 10 patients.