Vulnerability of an equine pericardial roll graft to Gram-positive cocci after graft replacement for a ruptured infected abdominal aorta

We describe the influence of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia on histopathological alteration of a glutaraldehyde-fixed equine pericardial roll (EPR) graft in a 77-year-old male who underwent in-situ EPR replacement of a ruptured infected abdominal aorta with concomitant repair of the perforated duodenum. The patient died of circulatory failure after septic shock due to MRSA infection and gastrointestinal bleeding on postoperative day (POD) 23. The autopsy revealed no perforation of the EPR graft or anastomotic disruption between the native abdominal aorta and EPR graft. Histological examination revealed that the inner layer of the EPR graft was colonized and damaged by Gram-positive cocci (MRSA suspected). We therefore suggest that the infection-resistant property of EPR grafts may be uncertain in patients with postoperative sustained MRSA bacteremia when these grafts are used for arterial reconstruction.