Long-Term Suppressive Antimicrobial Therapy in Prosthetic Vascular Graft Infection: A Retrospective Evaluation of a Cohort of Patients Enrolled at Tor Vergata Hospital in Rome.

Background: Prosthetic vascular graft infection (PVGI) is a rare but life-threatening complication. Graft replacement is the only curative option, but often unfeasible due to high mortality risk. Suppressive antimicrobial therapy (SAT) offers a viable alternative, though evidence on regimens and duration is limited. Methods: We conducted a retrospective study, reviewing records of PVGI patients during 2014-2025 aiming to evaluate the efficacy of SAT. SAT was considered effective when allowing infection control under treatment; patients were defined as cured if no relapse occurred after at least 6 months from discontinuation. Patients were classified according to the Management of Aortic Graft Infection Collaboration criteria and managed by a multidisciplinary team. Results: Thirty patients met the inclusion criteria; 5 underwent graft removal and 25 underwent SAT. Infections were diagnosed a median of 90 [30-1095] days postsurgery. Fever occur in 15/25 (60%) and abscess in 12/25 (48%) patients. Microbiological diagnosis was achieved in 17/25 (68%) cases. A long-acting antibiotic (LAA) was used in 6/25 (24%), with successful discontinuation in 3/6. Drug adverse events occurred in 8/25 (32%) patients and treatment failure was observed in 11 among all antibiotic regimens analyzed. Infection control during SAT was achieved in 10 (40%) patients. Ten patients discontinued SAT and 6/10 (60%) remained relapse-free after more than 6 months of follow-up. Conclusions: SAT is a valuable option for high-risk PVGI patients. LAA may represent an option. PET/CT remains key for diagnosis and monitoring. Further studies are needed to define optimal SAT duration and to improve long-term outcomes.