Clinical and Microbial Insights into Polymicrobial Vascular Graft Infections: A Prospective Observational Study

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Pedrett, Jana Epprecht, Bruno Ledergerber, Julian Bär, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7579415/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Mar, 2026 Read the published version in Infection → Version 1 posted 8 You are reading this latest preprint version Abstract Objectives Vascular graft/endograft infections (VGEI) are difficult-to-treat and associated with high morbidity and mortality. Up to 40% of VGEI are polymicrobial, complicating clinical management. This study investigates microbial interactions and their impact on clinical outcomes. Methods We analyzed patient characteristics and survival in poly- versus monomicrobial infections from the VASGRA cohort, a Swiss prospective observational study. Kaplan-Meier analysis and Cox proportional hazards models were used to assess survival. Furthermore, a subset of patient-derived bacterial strains underwent Quantitative Fitness Analysis (QFA) to quantify changes in fitness in mono- and polymicrobial conditions. Results Among 227 VGEI episodes, 81 (35.7%) were polymicrobial. The overall survival rate was 84.4% at two years and 77.5% at five years, with polymicrobial infections associated with lower survival (logrank ranktest p = 0.004). Multivariable analyses confirmed that polymicrobial infections (adjusted HR = 2.91, 95% CI: 1.56–5.42, p = 0.001), age per 10 years older (adjusted HR = 2.08, 95% CI: 1.28–3.40, p = 0.003), and diabetes mellitus (adjusted HR = 2.12, 95% CI: 1.08–4.13, p = 0.028), were independent risk factors for increased mortality. QFA of five strain pairs revealed diverse interaction patterns among pathogens, ranging from complete inhibition to enhanced growth in co-culture. Conclusion Polymicrobial infections, along with older age and diabetes mellitus, were identified as independent risk factors for increased mortality in VGEI patients. QFA revealed diverse bacterial interactions, highlighting the complexity of polymicrobial environments in VGEI. prosthetic vascular graft infections quantitative fitness analysis (QFA) polymicrobial infections microbe-microbe interactions Figures Figure 1 Figure 2 INTRODUCTION Vascular graft/endograft infections (VGEI) are severe complications occurring in 1–6% of vascular procedures [ 1 ]. Peripheral graft infections can lead to limb loss and rarely death, while aortic graft infections, though less frequent, have a mortality rate exceeding 20% [ 1 ]. Treatment typically involves surgery (total or partial graft explantation, debridement with/without negative pressure wound therapy) and antimicrobial therapy [ 1 , 2 ]. Most VGEI are caused by coagulase-negative staphylococci (40%) and Staphylococcus aureus (30%), with fungi accounting for 5–12% [ 1 – 4 ]. Polymicrobial VGEI occur in 24–41% of cases [ 3 – 7 ]. Polymicrobial infections worsen clinical outcome in prosthetic joint infection, infective endocarditis, and bloodstream infection, likely due to inadequate antimicrobial treatment and limited knowledge of optimal management [ 8 – 11 ]. The impact of polymicrobial communities on the clinical course of VGEI, however, remains unclear. Microorganisms within such communities can alter each other’s gene expression and metabolism, potentially influencing infection progression [ 12 – 14 ]. Quantitative fitness analysis (QFA) is a low-cost, high-throughput method for assessing a strain’s reproductive fitness, either alone or in competition with another strain [ 15 ]. This approach is ideal to study microbial interactions in polymicrobial infections. This project had two aims: to compare clinical characteristics and outcomes in polymicrobial versus monomicrobial VGEI in a clinical cohort study, and to quantify interspecies interactions between different microorganisms isolated from polymicrobial VGEI. MATERIALS AND METHODS Study design and setting This study was performed as part of VASGRA, a prospective cohort study at the University Hospital Zurich, Switzerland, enrolling patients aged ≥ 18 undergoing treatment for VGEI. Physicians and study nurses collected standardized demographic, clinical, surgical, and laboratory data every six months during study visits, with follow-up lasting up to 10 years. Tissue samples from surgical interventions were collected for further use. For this analysis, participants diagnosed with VGEI from January 2013 to March 2023 with at least one baseline and one follow-up visit were included. VGEI diagnosis followed the Management of Aortic Graft Infection Collaboration criteria [ 4 ], requiring either two major criteria or one major and one minor criterion from different categories. Multiple VGEI episodes per patient were recorded separately. The study was approved by the Institutional Review Board of Zurich, Switzerland (cohort study: KEK-ZH 2012 − 0583, PB_2016 − 01320; patient sample processing: KEK-ZH 2017–02225). Informed consent was obtained from all participants. Definitions A VGEI episode was categorized as polymicrobial if ≥ 2 microorganisms were cultured in ≥ 2 samples of perigraft tissue, graft material, or blood cultures. Potential contaminants, such as coagulase-negative staphylococci or Cutibacterium acnes , were considered significant if detected in ≥ 3 tissue samples or in both a tissue and a vascular graft sample. VGEI located in the abdomen or thorax were categorized as intracavitary abdominal or thoracic infections, respectively [ 1 ]. A VGEI episode was classified as “perioperative” if it occurred within one year of the index surgery, as “hematogenous” if associated with bacteremia, and as " per continuitatem " if arising from an adjacent infection (e.g. by fistula formation, infected perigraft hematoma, spondylodiscitis). Surgical treatment was categorized by the most extensive procedure performed within 180 days of VGEI diagnosis, ranging from complete graft excision to debridement or endovascular repair. The Charlson comorbidity index (CCI) assessed the severity of comorbidities [ 16 ], while malignancies were reported if active within the past five years. Clinical outcome The primary clinical outcome was patient survival in polymicrobial compared to monomicrobial VGEI, with a maximum follow-up period of 5 years. Patients lost to follow-up were censored at their last recorded timepoint with available survival data. Sample collection, processing, and quantitative fitness analysis (QFA) for colony growth dynamics Tissue and/or graft material from vascular procedures in VGEI patients were collected and processed as described by Bär et al. [ 17 ]. A subset of strain pairs from polymicrobial VGEI was selected for this study (convenience sample). QFA was employed to assess reproductive fitness variations among causative pathogens as described by Frey et al [ 15 ]. In brief, diluted bacterial cultures were spotted on BHI agar and timelapse imaging and analysis performed. Fitness was defined via the maximal growth rate and time to maximal growth rate from a Gompertz model fit. [ 15 , 18 ] Bacterial interactions were studied by comparing strain fitness in co-culture compared to monoculture, thus minimizing the influence of nutrient competition. Strain pairs were drop-plated (3µl per spot) in a predefined pattern to mimic co-culture (checkerboard of strain 1 and 2) and monoculture. Border culture spots were excluded from analysis to avoid environmental variability ( Supplementary Fig. 1 ). Statistical analyses Clinical data were analyzed to compare patient characteristics and survival between polymicrobial and monomicrobial VGEI. Categorical variables were expressed as numbers and percentages, while quantitative variables were presented as medians and interquartile range (IQR). Fisher’s exact test was used for categorical variables, and the Wilcoxon rank-sum test for continuous variables. Survival was calculated using Kaplan-Meier analyses, both overall and stratified by infection type (poly- vs. monomicrobial) with the log-rank test comparing groups. Cox proportional hazards models adjusting for key patient characteristics, including age, sex, body mass index (BMI), CCI, and VGEI location were employed. We applied robust standard errors to account for multiple episodes per patient. These analyses were conducted using Stata/SE 18.0 SE (StataCorp, College Station, TX, USA Texas Corp). Statistical analyses of the QFA data were performed using R 4.4.1 (R Foundation for Statistical Computing, Vienna Austria, URL https://www.R-project.org/ ), R Studio, and ggplot2 [ 19 ]. A linear mixed effects model was used to evaluate the three-way interaction between strain ID, patient ID and plate layout (mono- versus co-culture) on QFA fitness, incorporating a random intercept for biological replicates [ 20 ]. Post-hoc estimated marginal means tests were performed for each strain and patient to assess the effect of plate layout based on this model. [ 21 ]. RESULTS Population characteristics The analysis included 227 VGEI episodes from 222 patients, of which 81 episodes (35.7%) from 76 patients were classified as polymicrobial. Table 1 summarizes patient characteristics overall and stratified by poly- versus monomicrobial infections. Polymicrobial VGEI were predominantly extracavitary or intracavitary abdominal infections of per continuitatem or perioperative origin, whereas thoracic infections of hematogenous origin were more common in monomicrobial cases. Comorbidities were similar across groups, though peripheral arterial disease and fistula formation were more frequent in patients with polymicrobial infections. Gram-positive bacteria were the most frequently isolated pathogens, followed by Gram-negative and anaerobic bacteria. Fungi were notably more commonly found in polymicrobial infections (19.8% of polymicrobial episodes). Table 1 Baseline characteristics overall and stratified by poly- versus monomicrobial infections (n = 227) All VGEI episodes n = 227 Polymicrobial VGEI episodes n = 81 Monomicrobial VGEI episodes n = 146 P- value Female sex , n (%) 49 (21.6) 15 (18.5) 34 (23.3) 0.501 Age median [years] (IQR) 68 (60–76) 68 (60–75) 68.5 (60–76) 0.673 BMI median [kg/m 2 ] (IQR) 25.9 (23-28.4) 26.2 (23.3–29) 25.7 (23-28.4) 0.632 Smoking 1 0.155 Never, n (%) 67 (30.2) 18 (22.5) 49 (34.5) Current, n (%) 62 (27.9) 26 (32.5) 36 (25.4) Former, n (%) 93 (41.9) 36 (45.0) 57 (40.1) Alcohol consumption 2 , 0.662 None/ light n (%) 199 (88.4) 70 (87.5) 129 (88.9) Mod/severe, n (%) 26 (11.6) 10 (12.5) 16 (11.0) CCI , median (IQR) 2 (1–4) 2 (1–3) 2 (1–4) 0.922 Dyslipidemia , n (%) 144 (63.4) 57 (70.4) 87 (59.6) 0.117 Arterial hypertension , n (%) 176 (77.5) 65 (80.3) 111 (76.0) 0.230 Diabetes mellitus , n (%) 48 (21.2) 18 (22.2) 30 (20.6) 0.865 Diabetes mellitus with end-organ damage 3 , n (%) 14 (6.2) 7 (8.6) 7 (4.8) 0.262 Previous myocardial infarction , n (%) 39 (17.2) 13 (16.1) 26 (17.8) 0.855 Congestive heart failure , n (%) 24 (10.1) 6 (7.4) 18 (12.3) 0.367 Peripheral arterial disease , n (%) 85 (37.4) 42 (51.9) 43 (29.5) 0.001 Cerebrovascular disease , n (%) 51 (22.5) 14 (17.3) 37 (25.3) 0.186 Any malignancy within last 5 years , n (%) 41 (18.1) 19 (23.5) 22 (15.1) 0.149 Location of VGEI , n (%) < 0.001 Intracavitary abdominal 82 (36.1) 30 (37.0) 52 (35.6) Intracavitary thoracic 81 (35.7) 15 (18.5) 66 (45.2) Extracavitary 64 (28.2) 36 (44.4) 28 (19.2) Route of VGEI , n (%) < 0.001 Perioperative 62 (27.3) 32 (39.5) 30 (20.1) Hematogenous 62 (27.3) 9 (11.1) 53 (36.3) Per continuitatem 82 (36.1) 38 (46.9) 44 (30.1) Mycotic 21 (9.3) 2 (2.5) 19 (13.0) Fistula development , n (%) 59 (26.0) 33 (40.7) 26(17.8) < 0.001 Graft insertion in an infected site , n (%) 54(23.8) 18(22.2) 36(24.7) 0.746 Pathogens isolated < 0.001 Anaerobes, n (%) 38 (16.7) 27 (33.3) 11 (7.5) Fungi, n (%) 20 (8.8) 16 (19.8) 4 (2.7) Gram-negative, n (%) 70 (30.8) 50 (61.7) 20 (13.7) Gram-positive, n (%) 140 (61.7) 66 (81.5) 74 (50.7) Mycobacteria, n (%) 1 (0.4) 1 (1.2) 0(0) Mycoplasma, n (%) 2 (0.9) 0(0) 2 (1.4) Culture-neg., n (%) 35 (15.4) 0(0) 0(0) Surgical treatment 4 < 0.001 Complete excision of graft, n (%) 61 (26.9) 24 (29.6) 37 (25.3) Partial excision of graft, n (%) 13 (5.7) 6 (7.4) 7 (4.8) Debridement, n (%) 70 (30.8) 38 (46.9) 32 (21.9) Endovascular repair, n (%) 3 (1.3) 0(0) 3 (2.1) None, n (%) 80 (35.2) 13 (16.1) 67 (45.9) Notes : P -values calculated with Fisher’s exact test for categorical variables, Wilcoxon rank-sum test for continuous variables. 1 Missing values for smoking status for 5 episodes, total n = 222 2 Alcohol consumption was stratified based on the World Health Organization’s definition of light, moderate and severe use. Missing values for alcohol consumption for 2 episodes, total n = 225 3 End-organ damage defined as: retinopathy, neuropathy, nephropathy 4 Maximal intervention within 180 days of VGEI diagnosis. Survival of patients with polymicrobial vs. monomicrobial VGEI The overall survival rate was 84.4% (95% confidence interval [CI]: 78.7–88.7) at two years and 77.5% (70.2–83.3) at five years following VGEI diagnosis. Patients with polymicrobial VGEI had lower survival rates (Fig. 1 , log-rank-test p = 0.004). We also examined the association between clinical variables and mortality due to VGEI by calculating both unadjusted and adjusted hazard ratios (HRs) for various factors (Table 2 ). In the unadjusted analysis, polymicrobial infections were associated with a higher mortality risk compared to monomicrobial infections (HR = 2.42, 95% CI: 1.31–4.49, p = 0.005). Each 10-year increase in age also increased mortality risk (HR = 1.84, 1.24–2.72, p = 0.003). Diabetes mellitus was another significant factor (HR = 2.12, 1.08–4.13, p = 0.028). After adjusting for confounders, the association between polymicrobial infection and mortality was stronger (adjusted HR = 2.91, 95% CI: 1.56–5.42, p = 0.001), confirming the role of polymicrobial infection as a major risk factor for VGEI-related mortality. Age remained significantly associated with mortality (adjusted HR = 2.08 per 10 years older, 1.28–3.40, p = 0.003), highlighting it as an independent predictor of poor outcomes. Other factors, including sex, BMI, D. mellitus and CCI, had no significant effect on mortality in the adjusted model. Table 2 Results of unadjusted and adjusted Cox proportional hazards models for death Variable Unadjusted Adjusted 1 HR 95% CI P -value HR 95% CI P -value Monomicrobial ref ref Polymicrobial 2.42 1.31–4.49 0.005 2.91 1.56–5.42 0.001 Male ref ref Female 0.65 0.27–1.56 0.333 0.56 0.22–1.48 0.243 Age, per 10 years 1.84 1.24–2.72 0.003 2.08 1.28–3.40 0.003 BMI 30 kg/m 2 1.15 0.53–2.50 0.714 1.34 0.58–3.07 0.493 CCI > 4 1.87 0.94–3.72 0.075 1.85 0.92–3.74 0.086 Location Intracavitary abdominal ref ref Intracavitary thoracic 0.87 0.41–1.83 0.706 1.53 0.68–3.41 0.302 Extracavitary 1.26 0.60–2.62 0.546 1.05 0.48–2.32 0.900 Smoking Never ref Past 1.18 0.59–2.38 0.641 Current 0.62 0.26–1.48 0.282 Active malignancy 2 1.67 0.85–3.27 0.138 Coronary heart disease or heart failure 1.73 0.90–3.32 0.102 Diabetes mellitus 2.12 1.08–4.13 0.028 Peripheral arterial disease 1.04 0.55–1.96 0.912 Fistula development 0.76 0.36–1.59 0.469 Graft insertion in an infected site 1.51 0.77–2.97 0.232 Maximal operation within 180 days None ref Endovascular repair 4.23 0.45–39.4 0.206 Debridement 1.64 0.74–3.63 0.220 Partial graft removal 1.35 0.32–5.77 0.682 Complete graft removal 1.90 0.84–4.31 0.126 Quantification of fitness of different pathogens when grown in co-culture A total of 137 clinical samples were obtained from patients with VGEI. Five cases of VGEI with two concurrent causative pathogens were selected for QFA (Table 3 ). The clinical course of these five patients is detailed in the supplementary material ( Case descriptions and Supplementary Figs. 2 and 3a ). Table 3 Summary of clinical isolates and corresponding clinical information of 5 patients with polymicrobial VGEI Patient Nr. Bacterial species Sex Age IVDU Sample material Removal of prosthesis ICU stay Bacteraemia (days) Antibiotic treatment Death P1 C. amycolatum S. aureus M 60 Yes Deep wound tissue Yes No None TZP VA DAP CIP MTZ CN No P2 C. glabrata E. coli M 72 No Graft prosthesis Yes Yes None CAS TZP MEM DAP VA Yes P3 K. aerogenes C. glabrata M 53 Yes Deep wound tissue No No Yes (10) AMC VA CIP OX DAP CN ISA SXT RA No P4 E. faecalis C. amycolatum M 51 No Deep wound tissue No Yes None AMC Yes P5 S. epidermidis E. cloacae M 74 No Deep wound tissue No Yes No MEM VA No Using QFA, we quantified the reproductive fitness of five polymicrobial isolate pairs, revealing diverse interaction patterns among the strain pairs (Fig. 2 ). In patient 1, the growth of Corynebacterium amycolatum was significantly enhanced by Staphylococcus aureus , while S. aureus growth was inhibited by C. amycolatum , indicating a substantial interaction (p-value < 0.001; Supplementary Fig. 2 ). In patient 2, Candida glabrata was completely inhibited by Escherichia coli , while E. coli fitness remained unaffected by C. glabrata. Notably, C. glabrata did not grow on control spots, suggesting a potent inhibitory effect of E. coli. This was confirmed by an inhibition assay, where plating the two strains at increasing distances showed a decrease in inhibition with greater distance ( Supplementary Fig. 3b/c ) [ 22 ]. Co-culture experiments with Klebsiella aerogenes and Candida glabrata, Enterococcus faecalis and C. amycolatum , and Staphylococcus epidermidis and Enterobacter cloacae (patient 3, 4, and 5) all demonstrated significantly impaired growth of one or both isolates. DISCUSSION In this analysis of 227 VGEI episodes, we aimed to better characterize different aspects of polymicrobial infections. Clinically, we observed a nearly threefold increase in 5-year mortality risk for patients with polymicrobial infections after adjusting for age and comorbidities. From a microbiological perspective, QFA of five pathogen pairs from polymicrobial infections demonstrated to be a cost-effective method for revealing diverse interaction patterns. We primarily identified negative interactions (one- or two-sided inhibition), although some neutral or positive (one-sided) changes in fitness were also observed when comparing mono- to polymicrobial growth. Comparing our clinical results with age-matched cohorts with similar comorbidities is challenging due to the rarity of VGEI and limited available data [ 5 , 6 , 23 ]. A recent French cohort of patients with VGEI reported a five-year survival rate of 43.1% [ 24 ]. This could reflect differences in patient management strategies, healthcare resources, or demographic factors between the cohorts. The consistently higher survival rates across both short- and long-term follow-ups underscore the potential advantages of the multidisciplinary approach used in the VASGRA cohort. Recent studies on polymicrobial S. aureus bacteraemia report higher mortality rates in the polymicrobial infection group like our findings [ 25 ]. Observational studies of infective endocarditis also suggest an increased risk of complications and mortality in polymicrobial infections. [ 10 , 11 ] Polymicrobial infections and increasing age were consistently associated with a higher risk of mortality in both the unadjusted and adjusted models. Among frequent comorbidities, diabetes mellitus was associated with higher mortality in the unadjusted analysis, underscoring the importance of optimal management to improve patient outcomes. While the effect of factors such as sex, BMI, and smoking status on mortality remained uncertain, it is important to note that these variables may still have a role in influencing other aspects of the clinical course of VGEI, such as infection severity or recovery. Further studies with larger sample sizes may help clarify their potential indirect effects on mortality. Investigating pathogen interactions in polymicrobial infections could offer valuable insights into the pathophysiological processes contributing to poorer outcomes. Our study showed a reduction in the fitness of S. aureus in the presence of C. amycolatum , consistent with existing literature on the impact of Corynebacterium spp. on S. aureus colonization, viability, and virulence [ 12 , 13 , 26 ]. Microbe-microbe interactions, especially in the context of microbiota and infections, have been studied using various methods. Ramsey et al. used RNA sequencing to assess gene expression in S. aureus during mono- or co-culture with C. striatum , revealing increased expression of genes linked to nasal colonization and reduced expression of those associated with invasive infection. Additionally, S. aureus’s haemolytic capacity was reduced after exposure to C. striatum cell-free conditioned medium [ 13 ]. Another study demonstrated inhibitory activity against S. aureus by C. amycolatum through zone of clearance measurements on agar plates in both contact-dependent and -independent assays [ 12 ]. Further studies have explored microbe-microbe interactions by examining the effect of S. aureus on the mucosal barrier, with and without Corynebacterium supernatant, using confocal microscopy to assess barrier integrity [ 27 ]. In a mouse subcutaneous abscess model, colony-forming units (CFU) from mono- and coinfection abscesses of S. aureus and C. striatum were counted, showing a significant reduction in S. aureus CFUs in the presence of C. striatum [ 13 ]. Interestingly, our patient with S. aureus and C. amycolatum infection had a chronic, exuding wound from an infected vascular graft, suggesting that S. aureus may shift toward a more commensal behaviour in the presence of C. amycolatum [ 13 ]. We quantified the inhibitory effect of E. coli on C. glabrata , which aligns with existing literature demonstrating E. coli's inhibitory effects on various Candida species. Bandara et al. showed that E. coli secretory products significantly inhibited biofilm formation in six Candida spp. [ 28 ]. Similarly, Cabral et al. reported a fungicidal effect from both E. coli co-culture and E. coli -conditioned media on C. albicans , while E. coli ’s growth remained unaffected, suggesting the secretion of a fungicidal element [ 29 ]. Although no studies have specifically examined the interaction between K. aerogenes and C. glabrata , research involving caterpillar larvae suggests a synergistic pathogen-pathogen interaction in the biofilm of K. aerogenes and C. albicans [ 30 ]. Although we primarily observed antagonistic interactions between isolated strains, patients with polymicrobial infections experienced higher mortality rates, even after adjustment for age, graft location, and comorbidities. Several factors may contribute to this increased mortality risk, including the need for more toxic combination therapies, and complex interactions at both the microbe-microbe and microbe-host levels. Pathogen competition could result in persistent low-grade infections that are difficult to eradicate and may lead to altered inflammatory responses. Our study has several strengths, including the prospective enrolment of patients with incident VGEI and the use of patient-derived bacterial strains. To the best of our knowledge, this is the largest analysis of patient characteristics and outcomes in polymicrobial VGEI. We assessed the fitness of a wide range of pathogens from polymicrobial infections using solid agar to replicate the graft infection environment. By comparing mono- and co-cultures, we ruled out nutrient limitations as a factor affecting growth. Additionally, QFA enabled the measurement of full growth curves, including culture doubling time. Notably, QFA is cost-effective compared to other methods as it does not require fluorescence staining or microscopy and eliminates the need for time-consuming CFU-counting [ 13 , 27 ]. Our study has limitations. In the fitness analysis, we focused on a random subset of patient samples from a specific timeframe, without accounting for patient-specific factors. While the microbiological rationale for including diverse pathogens is clear, the clinical implications of observed fitness changes remain speculative. Our sampling strategy captured only a single timepoint in the infection process, limiting QFA's ability to discern the longitudinal impact of pathogen interactions. Despite these limitations, our approach provides qualitative insights into polymicrobial interactions. A more definitive understanding of the clinical effects of polymicrobial VGEI would require larger, in-depth epidemiological studies. In conclusion, our study establishes an analytical framework and an affordable method for quantifying polymicrobial interactions, while also paving the way for future research into the complex relationship between polymicrobial infections and clinical outcomes. Expanding this study to a larger scale with more patient samples and time points could provide valuable quantitative data. Future research using QFA has the potential to offer a deeper insight into pathogen interactions and their impact on clinical outcomes. Understanding the in vitro behaviour of pathogens may ultimately inform personalized patient management strategies. Declarations ACKNOWLEDGEMENTS AND FUNDING SOURCES This work was supported by the University of Zurich, Clinical Research Priority Program “Precision Medicine for Bacterial Infections” (to ASZ, BH, SDB) and the Swiss National Science Foundation grants #31003A_176252 (to ASZ); # 32003B_219351/1 (to BH); # 211422 (to SDB). Author contributions Conceptualization and Methodology: CIP, JE, BL, CTA, PMF, SDB, BH Investigation: CIP, JE, CTA, AT Software: JB, PMF Data Curation: CIP, JE, JB, BH Formal analysis: BL, JB, JBP Resources: BR, PMF, ASZ, SDB, BH Writing – original draft: CIP, JE Writing – Review & Editing: CIP, JE, BL, JB, AT, BR, PMF, ASZ, SDB, BH Approval of submitted version of the manuscript: all authors. Conflicts of interest The authors declare that they have no conflict of interest. Author Contribution Conceptualization and Methodology: CIP, JE, BL, CTA, PMF, SDB, BHInvestigation: CIP, JE, CTA, ATSoftware: JB, PMFData Curation: CIP, JE, JB, BHFormal analysis: BL, JB, JBPResources: BR, PMF, ASZ, SDB, BHWriting – original draft: CIP, JEWriting – Review & Editing: CIP, JE, BL, JB, AT, BR, PMF, ASZ, SDB, BHApproval of submitted version of the manuscript: all authors. Data Availability Data is provided within the manuscript or supplementary information files References Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement from the American Heart Association. vol. 134. 2016. https://doi.org/10.1161/CIR.0000000000000457. Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. 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Tables Table 1: Baseline characteristics overall and stratified by poly- versus monomicrobial infections (n=227) All VGEI episodes n=227 Polymicrobial VGEI episodes n=81 Monomicrobial VGEI episodes n=146 P- value Female sex , n (%) 49 (21.6) 15 (18.5) 34 (23.3) 0.501 Age median [years] (IQR) 68 (60-76) 68 (60-75) 68.5 (60-76) 0.673 BMI median [kg/m 2 ] (IQR) 25.9 (23-28.4) 26.2 (23.3-29) 25.7 (23-28.4) 0.632 Smoking 1 0.155 Never, n (%) 67 (30.2) 18 (22.5) 49 (34.5) Current, n (%) 62 (27.9) 26 (32.5) 36 (25.4) Former, n (%) 93 (41.9) 36 (45.0) 57 (40.1) Alcohol consumption 2 , 0.662 None/ light n (%) 199 (88.4) 70 (87.5) 129 (88.9) Mod/severe, n (%) 26 (11.6) 10 (12.5) 16 (11.0) CCI , median (IQR) 2 (1-4) 2 (1-3) 2 (1-4) 0.922 Dyslipidemia , n (%) 144 (63.4) 57 (70.4) 87 (59.6) 0.117 Arterial hypertension , n (%) 176 (77.5) 65 (80.3) 111 (76.0) 0.230 Diabetes mellitus , n (%) 48 (21.2) 18 (22.2) 30 (20.6) 0.865 Diabetes mellitus with end-organ damage 3 , n (%) 14 (6.2) 7 (8.6) 7 (4.8) 0.262 Previous myocardial infarction , n (%) 39 (17.2) 13 (16.1) 26 (17.8) 0.855 Congestive heart failure , n (%) 24 (10.1) 6 (7.4) 18 (12.3) 0.367 Peripheral arterial disease , n (%) 85 (37.4) 42 (51.9) 43 (29.5) 0.001 Cerebrovascular disease , n (%) 51 (22.5) 14 (17.3) 37 (25.3) 0.186 Any malignancy within last 5 years , n (%) 41 (18.1) 19 (23.5) 22 (15.1) 0.149 Location of VGEI , n (%) <0.001 Intracavitary abdominal 82 (36.1) 30 (37.0) 52 (35.6) Intracavitary thoracic 81 (35.7) 15 (18.5) 66 (45.2) Extracavitary 64 (28.2) 36 (44.4) 28 (19.2) Route of VGEI , n (%) <0.001 Perioperative 62 (27.3) 32 (39.5) 30 (20.1) Hematogenous 62 (27.3) 9 (11.1) 53 (36.3) Per continuitatem 82 (36.1) 38 (46.9) 44 (30.1) Mycotic 21 (9.3) 2 (2.5) 19 (13.0) Fistula development , n (%) 59 (26.0) 33 (40.7) 26 (17.8) <0.001 Graft insertion in an infected site , n (%) 54 (23.8) 18 (22.2) 36 (24.7) 0.746 Pathogens isolated <0.001 Anaerobes, n (%) 38 (16.7) 27 (33.3) 11 (7.5) Fungi, n (%) 20 (8.8) 16 (19.8) 4 (2.7) Gram-negative, n (%) 70 (30.8) 50 (61.7) 20 (13.7) Gram-positive, n (%) 140 (61.7) 66 (81.5) 74 (50.7) Mycobacteria, n (%) 1 (0.4) 1 (1.2) 0 (0) Mycoplasma, n (%) 2 (0.9) 0 (0) 2 (1.4) Culture-neg., n (%) 35 (15.4) 0 (0) 0 (0) Surgical treatment 4 <0.001 Complete excision of graft, n (%) 61 (26.9) 24 (29.6) 37 (25.3) Partial excision of graft, n (%) 13 (5.7) 6 (7.4) 7 (4.8) Debridement, n (%) 70 (30.8) 38 (46.9) 32 (21.9) Endovascular repair, n (%) 3 (1.3) 0 (0) 3 (2.1) None, n (%) 80 (35.2) 13 (16.1) 67 (45.9) Notes : P -values calculated with Fisher’s exact test for categorical variables, Wilcoxon rank-sum test for continuous variables. 1 Missing values for smoking status for 5 episodes, total n=222 2 Alcohol consumption was stratified based on the World Health Organization’s definition of light, moderate and severe use. Missing values for alcohol consumption for 2 episodes, total n=225 3 End-organ damage defined as: retinopathy, neuropathy, nephropathy 4 Maximal intervention within 180 days of VGEI diagnosis. Abbreviations : BMI, body mass index; CCI, Charlson Comorbidity Index; IQR, interquartile range; mod, moderate; neg, negative; VGEI, Vascular graft/endograft infection. Table 2: Results of unadjusted and adjusted Cox proportional hazards models for death Variable Unadjusted Adjusted 1 HR 95% CI P -value HR 95% CI P -value Monomicrobial ref ref Polymicrobial 2.42 1.31-4.49 0.005 2.91 1.56-5.42 0.001 Male ref ref Female 0.65 0.27-1.56 0.333 0.56 0.22-1.48 0.243 Age, per 10 years 1.84 1.24-2.72 0.003 2.08 1.28-3.40 0.003 BMI 30 kg/m 2 1.15 0.53-2.50 0.714 1.34 0.58-3.07 0.493 CCI >4 1.87 0.94-3.72 0.075 1.85 0.92-3.74 0.086 Location Intracavitary abdominal ref ref Intracavitary thoracic 0.87 0.41-1.83 0.706 1.53 0.68-3.41 0.302 Extracavitary 1.26 0.60-2.62 0.546 1.05 0.48-2.32 0.900 Smoking Never ref Past 1.18 0.59-2.38 0.641 Current 0.62 0.26-1.48 0.282 Active malignancy 2 1.67 0.85-3.27 0.138 Coronary heart disease or heart failure 1.73 0.90-3.32 0.102 Diabetes mellitus 2.12 1.08-4.13 0.028 Peripheral arterial disease 1.04 0.55-1.96 0.912 Fistula development 0.76 0.36-1.59 0.469 Graft insertion in an infected site 1.51 0.77-2.97 0.232 Maximal operation within 180 days None ref Endovascular repair 4.23 0.45-39.4 0.206 Debridement 1.64 0.74-3.63 0.220 Partial graft removal 1.35 0.32-5.77 0.682 Complete graft removal 1.90 0.84-4.31 0.126 Abbreviations : BMI, body mass index; CCI, Charlson Comorbidity Index; CI, Confidence interval; HR, Hazards ratio. Notes : Total n=227. 1 Adjusted for sex, age, BMI, CCI, graft location. 2 Defined as: Malignancy diagnosed or treated within the last 5 years (solid or hematologic). Table 3: Summary of clinical isolates and corresponding clinical information of 5 patients with polymicrobial VGEI Patient Nr. Bacterial species Sex Age IVDU Sample material Removal of prosthesis ICU stay Bacteraemia (days) Antibiotic treatment Death P1 C. amycolatum S. aureus M 60 Yes Deep wound tissue Yes No None TZP VA DAP CIP MTZ CN No P2 C. glabrata E. coli M 72 No Graft prosthesis Yes Yes None CAS TZP MEM DAP VA Yes P3 K. aerogenes C. glabrata M 53 Yes Deep wound tissue No No Yes (10) AMC VA CIP OX DAP CN ISA SXT RA No P4 E. faecalis C. amycolatum M 51 No Deep wound tissue No Yes None AMC Yes P5 S. epidermidis E. cloacae M 74 No Deep wound tissue No Yes No MEM VA No Abbreviations : M, Male; IVDU, Intravenous drug use; ICU, intensive care unit; C. amycolatum , Corynebacterium amycolatum; C. glabrata, Candida glabrata; E. cloacae, Enterobacter cloacae; E. faecalis, Enterococcus faecalis; E. coli, Escherichia coli; K. aerogenes, Klebsiella aerogenes; S. aureus, Staphylcococcus aureus; E. epidermidis, Staphylococcus epidermidis ; AMC, Amoxicillin-clavulanic acid; CAS, Caspofungin; CIP, Ciprofloxacin; SXT, Trimethoprim/Sulfamethoxazol; DAP, Daptomycin; OX, Flucloxacillin; CN, Gentamicin; ISA, Isavuconazol; MTZ, Metronidazol; MEM, Meropenem; TAZ, Piperacillin/Tazobactam; RA, Rifampicin; VA, Vancomycin. 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10:20:19","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121730,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/afad508e50d392ef5960e593.png"},{"id":91847832,"identity":"5df5c243-1b1e-4ade-b35e-f0f2d4457abb","added_by":"auto","created_at":"2025-09-22 10:28:20","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":130399,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/d32eb03a9446cfabab06e3af.png"},{"id":91847833,"identity":"885901df-8fd2-4b4b-9bbc-5da3646f4d4b","added_by":"auto","created_at":"2025-09-22 10:28:20","extension":"xml","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":142575,"visible":true,"origin":"","legend":"","description":"","filename":"e6b5d04a74bb4f3c8ee7b6f58f14a09f1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/c1e465392bb4c0b3c5a854e5.xml"},{"id":91846753,"identity":"10043c2e-770d-4c22-ade9-7875e67ae946","added_by":"auto","created_at":"2025-09-22 10:20:20","extension":"html","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":156018,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/587459c36dd50db9230d55a4.html"},{"id":91846730,"identity":"4464d363-4b1b-4e13-8b19-26157d5f6b5d","added_by":"auto","created_at":"2025-09-22 10:20:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69746,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan Meier curve for 5-year survival stratified by polymicrobial versus monomicrobial VGEI (n=227)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend: \u003c/strong\u003eUnadjusted 5-year survival stratified by poly- versus monomicrobial infection with corresponding 95% Confidence Interval is shown, demonstrating significantly higher mortality in patients with polymicrobial VGEI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: VGEI, vascular graft/endograft infection.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/8543c895bd2b0d9818f7e87c.png"},{"id":91846731,"identity":"6cbf9764-f30a-41aa-bba4-c048248610b1","added_by":"auto","created_at":"2025-09-22 10:20:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":232891,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFitness of five strain pairs from five patients with polymicrobial VGEI in mono- vs. co-culture\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure legend\u003c/strong\u003e: Plate growth was tracked using time-lapse imaging over a 48-hour period, and the absolute fitness was subsequently calculated. The absolute fitness of all pathogens was assessed in mono- (blue) and in co-culture with the corresponding second isolate from each strain pair (red). Each data point represents a single technical replicate, and the mean +/- standard deviation is indicated for each pathogen and layout (mono- versus co-culture). P-values for each pathogen are for interaction effect of mono- vs. co-culture assessed with a linear mixed-effect model. We used separate culture plates for \u003cem\u003eC. glabrata\u003c/em\u003e monoculture (P2), as the strong growth inhibiting effect of \u003cem\u003eE. coli\u003c/em\u003e did not allow to assess this condition on the same plate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: NI, normalized intensity.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/fd5ad45e0793e864fdea7887.png"},{"id":105754992,"identity":"8db4ecee-84c2-40d4-8aa7-603d903bd20a","added_by":"auto","created_at":"2026-03-30 16:23:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2492863,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/fc9df7a0-1bf4-451a-b170-70fcd50157be.pdf"},{"id":91847823,"identity":"d9dad3ed-be15-4ce9-98fb-07d169aaeed4","added_by":"auto","created_at":"2025-09-22 10:28:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1180468,"visible":true,"origin":"","legend":"","description":"","filename":"SUPPLEMENTARYMATERIAL.docx","url":"https://assets-eu.researchsquare.com/files/rs-7579415/v1/2cfdf8d9126efc835b250722.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical and Microbial Insights into Polymicrobial Vascular Graft Infections: A Prospective Observational Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eVascular graft/endograft infections (VGEI) are severe complications occurring in 1\u0026ndash;6% of vascular procedures [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Peripheral graft infections can lead to limb loss and rarely death, while aortic graft infections, though less frequent, have a mortality rate exceeding 20% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Treatment typically involves surgery (total or partial graft explantation, debridement with/without negative pressure wound therapy) and antimicrobial therapy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Most VGEI are caused by coagulase-negative staphylococci (40%) and \u003cem\u003eStaphylococcus aureus\u003c/em\u003e (30%), with fungi accounting for 5\u0026ndash;12% [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePolymicrobial VGEI occur in 24\u0026ndash;41% of cases [\u003cspan additionalcitationids=\"CR4 CR5 CR6\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Polymicrobial infections worsen clinical outcome in prosthetic joint infection, infective endocarditis, and bloodstream infection, likely due to inadequate antimicrobial treatment and limited knowledge of optimal management [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The impact of polymicrobial communities on the clinical course of VGEI, however, remains unclear. Microorganisms within such communities can alter each other\u0026rsquo;s gene expression and metabolism, potentially influencing infection progression [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Quantitative fitness analysis (QFA) is a low-cost, high-throughput method for assessing a strain\u0026rsquo;s reproductive fitness, either alone or in competition with another strain [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This approach is ideal to study microbial interactions in polymicrobial infections.\u003c/p\u003e\u003cp\u003eThis project had two aims: to compare clinical characteristics and outcomes in polymicrobial versus monomicrobial VGEI in a clinical cohort study, and to quantify interspecies interactions between different microorganisms isolated from polymicrobial VGEI.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and setting\u003c/h2\u003e\u003cp\u003eThis study was performed as part of VASGRA, a prospective cohort study at the University Hospital Zurich, Switzerland, enrolling patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 undergoing treatment for VGEI. Physicians and study nurses collected standardized demographic, clinical, surgical, and laboratory data every six months during study visits, with follow-up lasting up to 10 years. Tissue samples from surgical interventions were collected for further use.\u003c/p\u003e\u003cp\u003eFor this analysis, participants diagnosed with VGEI from January 2013 to March 2023 with at least one baseline and one follow-up visit were included. VGEI diagnosis followed the Management of Aortic Graft Infection Collaboration criteria [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], requiring either two major criteria or one major and one minor criterion from different categories. Multiple VGEI episodes per patient were recorded separately.\u003c/p\u003e\u003cp\u003eThe study was approved by the Institutional Review Board of Zurich, Switzerland (cohort study: KEK-ZH 2012\u0026thinsp;\u0026minus;\u0026thinsp;0583, PB_2016\u0026thinsp;\u0026minus;\u0026thinsp;01320; patient sample processing: KEK-ZH 2017\u0026ndash;02225). Informed consent was obtained from all participants.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDefinitions\u003c/h3\u003e\n\u003cp\u003eA VGEI episode was categorized as polymicrobial if\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2 microorganisms were cultured in \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;2 samples of perigraft tissue, graft material, or blood cultures. Potential contaminants, such as coagulase-negative staphylococci or \u003cem\u003eCutibacterium acnes\u003c/em\u003e, were considered significant if detected in \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;3 tissue samples or in both a tissue and a vascular graft sample.\u003c/p\u003e\u003cp\u003eVGEI located in the abdomen or thorax were categorized as intracavitary abdominal or thoracic infections, respectively [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A VGEI episode was classified as \u0026ldquo;perioperative\u0026rdquo; if it occurred within one year of the index surgery, as \u0026ldquo;hematogenous\u0026rdquo; if associated with bacteremia, and as \"\u003cem\u003eper continuitatem\u003c/em\u003e\" if arising from an adjacent infection (e.g. by fistula formation, infected perigraft hematoma, spondylodiscitis). Surgical treatment was categorized by the most extensive procedure performed within 180 days of VGEI diagnosis, ranging from complete graft excision to debridement or endovascular repair. The Charlson comorbidity index (CCI) assessed the severity of comorbidities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], while malignancies were reported if active within the past five years.\u003c/p\u003e\n\u003ch3\u003eClinical outcome\u003c/h3\u003e\n\u003cp\u003eThe primary clinical outcome was patient survival in polymicrobial compared to monomicrobial VGEI, with a maximum follow-up period of 5 years. Patients lost to follow-up were censored at their last recorded timepoint with available survival data.\u003c/p\u003e\n\u003ch3\u003eSample collection, processing, and quantitative fitness analysis (QFA) for colony growth dynamics\u003c/h3\u003e\n\u003cp\u003eTissue and/or graft material from vascular procedures in VGEI patients were collected and processed as described by B\u0026auml;r et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A subset of strain pairs from polymicrobial VGEI was selected for this study (convenience sample). QFA was employed to assess reproductive fitness variations among causative pathogens as described by Frey et al [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In brief, diluted bacterial cultures were spotted on BHI agar and timelapse imaging and analysis performed. Fitness was defined via the maximal growth rate and time to maximal growth rate from a Gompertz model fit. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Bacterial interactions were studied by comparing strain fitness in co-culture compared to monoculture, thus minimizing the influence of nutrient competition. Strain pairs were drop-plated (3\u0026micro;l per spot) in a predefined pattern to mimic co-culture (checkerboard of strain 1 and 2) and monoculture. Border culture spots were excluded from analysis to avoid environmental variability (\u003cb\u003eSupplementary Fig.\u0026nbsp;1\u003c/b\u003e).\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eClinical data were analyzed to compare patient characteristics and survival between polymicrobial and monomicrobial VGEI. Categorical variables were expressed as numbers and percentages, while quantitative variables were presented as medians and interquartile range (IQR). Fisher\u0026rsquo;s exact test was used for categorical variables, and the Wilcoxon rank-sum test for continuous variables.\u003c/p\u003e\u003cp\u003eSurvival was calculated using Kaplan-Meier analyses, both overall and stratified by infection type (poly- vs. monomicrobial) with the log-rank test comparing groups. Cox proportional hazards models adjusting for key patient characteristics, including age, sex, body mass index (BMI), CCI, and VGEI location were employed. We applied robust standard errors to account for multiple episodes per patient. These analyses were conducted using Stata/SE 18.0 SE (StataCorp, College Station, TX, USA Texas Corp).\u003c/p\u003e\u003cp\u003eStatistical analyses of the QFA data were performed using R 4.4.1 (R Foundation for Statistical Computing, Vienna Austria, URL \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.R-project.org/\u003c/span\u003e\u003cspan address=\"https://www.R-project.org/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), R Studio, and ggplot2 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A linear mixed effects model was used to evaluate the three-way interaction between strain ID, patient ID and plate layout (mono- versus co-culture) on QFA fitness, incorporating a random intercept for biological replicates [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. \u003cem\u003ePost-hoc\u003c/em\u003e estimated marginal means tests were performed for each strain and patient to assess the effect of plate layout based on this model. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003ePopulation characteristics\u003c/h2\u003e\u003cp\u003eThe analysis included 227 VGEI episodes from 222 patients, of which 81 episodes (35.7%) from 76 patients were classified as polymicrobial. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes patient characteristics overall and stratified by poly- versus monomicrobial infections. Polymicrobial VGEI were predominantly extracavitary or intracavitary abdominal infections of \u003cem\u003eper continuitatem\u003c/em\u003e or perioperative origin, whereas thoracic infections of hematogenous origin were more common in monomicrobial cases. Comorbidities were similar across groups, though peripheral arterial disease and fistula formation were more frequent in patients with polymicrobial infections. Gram-positive bacteria were the most frequently isolated pathogens, followed by Gram-negative and anaerobic bacteria. Fungi were notably more commonly found in polymicrobial infections (19.8% of polymicrobial episodes).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline characteristics overall and stratified by poly- versus monomicrobial infections (n\u0026thinsp;=\u0026thinsp;227)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll\u003c/p\u003e\u003cp\u003eVGEI episodes\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;227\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePolymicrobial\u003c/p\u003e\u003cp\u003eVGEI episodes\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;81\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMonomicrobial\u003c/p\u003e\u003cp\u003eVGEI episodes\u003c/p\u003e\u003cp\u003en\u0026thinsp;=\u0026thinsp;146\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale sex\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (21.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34 (23.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.501\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003cp\u003emedian [years] (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (60\u0026ndash;76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (60\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e68.5 (60\u0026ndash;76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.673\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003cp\u003emedian [kg/m\u003csup\u003e2\u003c/sup\u003e] (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.9 (23-28.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26.2 (23.3\u0026ndash;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.7 (23-28.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67 (30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (34.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (27.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (32.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (25.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormer, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93 (41.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (45.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57 (40.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol consumption\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.662\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone/ light n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e199 (88.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70 (87.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e129 (88.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMod/severe, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (11.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (12.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCI\u003c/b\u003e, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDyslipidemia\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144 (63.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57 (70.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e87 (59.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArterial hypertension\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176 (77.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65 (80.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e111 (76.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes mellitus\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (20.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.865\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes mellitus with end-organ damage\u003c/b\u003e\u003csup\u003e3\u003c/sup\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (6.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (8.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.262\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrevious myocardial infarction\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCongestive heart failure\u003c/b\u003e,\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24 (10.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (12.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.367\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeripheral arterial disease\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85 (37.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42 (51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (29.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCerebrovascular disease\u003c/b\u003e,\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51 (22.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (17.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.186\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAny malignancy within last 5 years\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (18.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19 (23.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (15.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.149\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation of VGEI\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracavitary abdominal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (36.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (37.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracavitary thoracic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (18.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e66 (45.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtracavitary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (28.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36 (44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28 (19.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRoute of VGEI\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerioperative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32 (39.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30 (20.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematogenous\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (36.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003ePer continuitatem\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (36.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (46.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (30.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMycotic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21 (9.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19 (13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFistula development\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59 (26.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (40.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26(17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGraft insertion in an infected site\u003c/b\u003e, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54(23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18(22.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36(24.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.746\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePathogens isolated\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAnaerobes, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (7.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFungi, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20 (8.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16 (19.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGram-negative, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50 (61.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20 (13.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGram-positive, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e140 (61.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (81.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e74 (50.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMycobacteria, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMycoplasma, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCulture-neg., n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSurgical treatment\u003c/b\u003e \u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplete excision of graft, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (26.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartial excision of graft, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13 (5.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (7.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (4.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDebridement, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e70 (30.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (46.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndovascular repair,\u003c/p\u003e\u003cp\u003en (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (2.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80 (35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (16.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67 (45.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNotes\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eP\u003c/em\u003e-values calculated with Fisher\u0026rsquo;s exact test for categorical variables, Wilcoxon rank-sum test for continuous variables.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e1\u003c/sup\u003e Missing values for smoking status for 5 episodes, total n\u0026thinsp;=\u0026thinsp;222\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e2\u003c/sup\u003e Alcohol consumption was stratified based on the World Health Organization\u0026rsquo;s definition of light, moderate and severe use. Missing values for alcohol consumption for 2 episodes, total n\u0026thinsp;=\u0026thinsp;225\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e3\u003c/sup\u003e End-organ damage defined as: retinopathy, neuropathy, nephropathy\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003e4\u003c/sup\u003e Maximal intervention within 180 days of VGEI diagnosis.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eSurvival of patients with polymicrobial vs. monomicrobial VGEI\u003c/h3\u003e\n\u003cp\u003eThe overall survival rate was 84.4% (95% confidence interval [CI]: 78.7\u0026ndash;88.7) at two years and 77.5% (70.2\u0026ndash;83.3) at five years following VGEI diagnosis. Patients with polymicrobial VGEI had lower survival rates (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e, log-rank-test p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\u003cp\u003eWe also examined the association between clinical variables and mortality due to VGEI by calculating both unadjusted and adjusted hazard ratios (HRs) for various factors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the unadjusted analysis, polymicrobial infections were associated with a higher mortality risk compared to monomicrobial infections (HR\u0026thinsp;=\u0026thinsp;2.42, 95% CI: 1.31\u0026ndash;4.49, p\u0026thinsp;=\u0026thinsp;0.005). Each 10-year increase in age also increased mortality risk (HR\u0026thinsp;=\u0026thinsp;1.84, 1.24\u0026ndash;2.72, p\u0026thinsp;=\u0026thinsp;0.003). Diabetes mellitus was another significant factor (HR\u0026thinsp;=\u0026thinsp;2.12, 1.08\u0026ndash;4.13, p\u0026thinsp;=\u0026thinsp;0.028). After adjusting for confounders, the association between polymicrobial infection and mortality was stronger (adjusted HR\u0026thinsp;=\u0026thinsp;2.91, 95% CI: 1.56\u0026ndash;5.42, p\u0026thinsp;=\u0026thinsp;0.001), confirming the role of polymicrobial infection as a major risk factor for VGEI-related mortality. Age remained significantly associated with mortality (adjusted HR\u0026thinsp;=\u0026thinsp;2.08 per 10 years older, 1.28\u0026ndash;3.40, p\u0026thinsp;=\u0026thinsp;0.003), highlighting it as an independent predictor of poor outcomes. Other factors, including sex, BMI, D. mellitus and CCI, had no significant effect on mortality in the adjusted model.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of unadjusted and adjusted Cox proportional hazards models for death\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eUnadjusted\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eAdjusted \u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e95% CI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonomicrobial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePolymicrobial\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.31\u0026ndash;4.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.56\u0026ndash;5.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.27\u0026ndash;1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.22\u0026ndash;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, per 10 years\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.24\u0026ndash;2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.28\u0026ndash;3.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;30 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.38\u0026ndash;1.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.36\u0026ndash;1.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.405\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;30 kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.53\u0026ndash;2.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.714\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.58\u0026ndash;3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.493\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCCI\u0026thinsp;\u0026gt;\u0026thinsp;4\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.94\u0026ndash;3.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.92\u0026ndash;3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracavitary abdominal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntracavitary thoracic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.41\u0026ndash;1.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.68\u0026ndash;3.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.302\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExtracavitary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.60\u0026ndash;2.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.546\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.48\u0026ndash;2.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.900\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePast\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59\u0026ndash;2.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.641\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurrent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.26\u0026ndash;1.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.282\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eActive malignancy\u003c/b\u003e \u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.85\u0026ndash;3.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCoronary heart disease or heart failure\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.90\u0026ndash;3.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDiabetes mellitus\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.08\u0026ndash;4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeripheral arterial disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.55\u0026ndash;1.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.912\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFistula development\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.36\u0026ndash;1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGraft insertion in an infected site\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.77\u0026ndash;2.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMaximal operation within 180 days\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eref\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEndovascular repair\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.45\u0026ndash;39.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDebridement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.74\u0026ndash;3.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartial graft removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.32\u0026ndash;5.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplete graft removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.84\u0026ndash;4.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.126\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eQuantification of fitness of different pathogens when grown in co-culture\u003c/h2\u003e\u003cp\u003eA total of 137 clinical samples were obtained from patients with VGEI. Five cases of VGEI with two concurrent causative pathogens were selected for QFA (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The clinical course of these five patients is detailed in the supplementary material (\u003cb\u003eCase descriptions\u003c/b\u003e and \u003cb\u003eSupplementary Figs.\u0026nbsp;2 and 3a\u003c/b\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSummary of clinical isolates and corresponding clinical information of 5 patients with polymicrobial VGEI\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient Nr.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBacterial species\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIVDU\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSample material\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRemoval of prosthesis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eICU stay\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eBacteraemia (days)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eAntibiotic treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eC. amycolatum\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeep wound tissue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eTZP\u003c/p\u003e\u003cp\u003eVA\u003c/p\u003e\u003cp\u003eDAP\u003c/p\u003e\u003cp\u003eCIP\u003c/p\u003e\u003cp\u003eMTZ\u003c/p\u003e\u003cp\u003eCN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGraft prosthesis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCAS\u003c/p\u003e\u003cp\u003eTZP\u003c/p\u003e\u003cp\u003eMEM\u003c/p\u003e\u003cp\u003eDAP\u003c/p\u003e\u003cp\u003eVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eK. aerogenes\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeep wound tissue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eYes (10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eAMC\u003c/p\u003e\u003cp\u003eVA\u003c/p\u003e\u003cp\u003eCIP\u003c/p\u003e\u003cp\u003eOX\u003c/p\u003e\u003cp\u003eDAP\u003c/p\u003e\u003cp\u003eCN\u003c/p\u003e\u003cp\u003eISA\u003c/p\u003e\u003cp\u003eSXT\u003c/p\u003e\u003cp\u003eRA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eE. faecalis\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eC. amycolatum\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeep wound tissue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eAMC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eP5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eS. epidermidis\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eE. cloacae\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDeep wound tissue\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003eMEM\u003c/p\u003e\u003cp\u003eVA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUsing QFA, we quantified the reproductive fitness of five polymicrobial isolate pairs, revealing diverse interaction patterns among the strain pairs (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In patient 1, the growth of \u003cem\u003eCorynebacterium amycolatum\u003c/em\u003e was significantly enhanced by \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, while \u003cem\u003eS. aureus\u003c/em\u003e growth was inhibited by \u003cem\u003eC. amycolatum\u003c/em\u003e, indicating a substantial interaction (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cb\u003eSupplementary Fig.\u0026nbsp;2\u003c/b\u003e). In patient 2, \u003cem\u003eCandida glabrata\u003c/em\u003e was completely inhibited by \u003cem\u003eEscherichia coli\u003c/em\u003e, while \u003cem\u003eE. coli\u003c/em\u003e fitness remained unaffected by \u003cem\u003eC. glabrata.\u003c/em\u003e Notably, \u003cem\u003eC. glabrata\u003c/em\u003e did not grow on control spots, suggesting a potent inhibitory effect of \u003cem\u003eE. coli.\u003c/em\u003e This was confirmed by an inhibition assay, where plating the two strains at increasing distances showed a decrease in inhibition with greater distance (\u003cb\u003eSupplementary Fig.\u0026nbsp;3b/c\u003c/b\u003e) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Co-culture experiments with \u003cem\u003eKlebsiella aerogenes\u003c/em\u003e and \u003cem\u003eCandida glabrata, Enterococcus faecalis\u003c/em\u003e and \u003cem\u003eC. amycolatum\u003c/em\u003e, and \u003cem\u003eStaphylococcus epidermidis\u003c/em\u003e and \u003cem\u003eEnterobacter cloacae\u003c/em\u003e (patient 3, 4, and 5) all demonstrated significantly impaired growth of one or both isolates.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this analysis of 227 VGEI episodes, we aimed to better characterize different aspects of polymicrobial infections. Clinically, we observed a nearly threefold increase in 5-year mortality risk for patients with polymicrobial infections after adjusting for age and comorbidities. From a microbiological perspective, QFA of five pathogen pairs from polymicrobial infections demonstrated to be a cost-effective method for revealing diverse interaction patterns. We primarily identified negative interactions (one- or two-sided inhibition), although some neutral or positive (one-sided) changes in fitness were also observed when comparing mono- to polymicrobial growth.\u003c/p\u003e\u003cp\u003eComparing our clinical results with age-matched cohorts with similar comorbidities is challenging due to the rarity of VGEI and limited available data [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A recent French cohort of patients with VGEI reported a five-year survival rate of 43.1% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This could reflect differences in patient management strategies, healthcare resources, or demographic factors between the cohorts. The consistently higher survival rates across both short- and long-term follow-ups underscore the potential advantages of the multidisciplinary approach used in the VASGRA cohort.\u003c/p\u003e\u003cp\u003eRecent studies on polymicrobial \u003cem\u003eS. aureus\u003c/em\u003e bacteraemia report higher mortality rates in the polymicrobial infection group like our findings [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Observational studies of infective endocarditis also suggest an increased risk of complications and mortality in polymicrobial infections. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Polymicrobial infections and increasing age were consistently associated with a higher risk of mortality in both the unadjusted and adjusted models. Among frequent comorbidities, diabetes mellitus was associated with higher mortality in the unadjusted analysis, underscoring the importance of optimal management to improve patient outcomes. While the effect of factors such as sex, BMI, and smoking status on mortality remained uncertain, it is important to note that these variables may still have a role in influencing other aspects of the clinical course of VGEI, such as infection severity or recovery. Further studies with larger sample sizes may help clarify their potential indirect effects on mortality.\u003c/p\u003e\u003cp\u003eInvestigating pathogen interactions in polymicrobial infections could offer valuable insights into the pathophysiological processes contributing to poorer outcomes. Our study showed a reduction in the fitness of \u003cem\u003eS. aureus\u003c/em\u003e in the presence of \u003cem\u003eC. amycolatum\u003c/em\u003e, consistent with existing literature on the impact of \u003cem\u003eCorynebacterium\u003c/em\u003e spp. on \u003cem\u003eS. aureus\u003c/em\u003e colonization, viability, and virulence [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Microbe-microbe interactions, especially in the context of microbiota and infections, have been studied using various methods. Ramsey et al. used RNA sequencing to assess gene expression in \u003cem\u003eS. aureus\u003c/em\u003e during mono- or co-culture with \u003cem\u003eC. striatum\u003c/em\u003e, revealing increased expression of genes linked to nasal colonization and reduced expression of those associated with invasive infection. Additionally, \u003cem\u003eS. aureus\u0026rsquo;s\u003c/em\u003e haemolytic capacity was reduced after exposure to \u003cem\u003eC. striatum\u003c/em\u003e cell-free conditioned medium [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another study demonstrated inhibitory activity against \u003cem\u003eS. aureus\u003c/em\u003e by \u003cem\u003eC. amycolatum\u003c/em\u003e through zone of clearance measurements on agar plates in both contact-dependent and -independent assays [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFurther studies have explored microbe-microbe interactions by examining the effect of \u003cem\u003eS. aureus\u003c/em\u003e on the mucosal barrier, with and without \u003cem\u003eCorynebacterium\u003c/em\u003e supernatant, using confocal microscopy to assess barrier integrity [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a mouse subcutaneous abscess model, colony-forming units (CFU) from mono- and coinfection abscesses of \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eC. striatum\u003c/em\u003e were counted, showing a significant reduction in \u003cem\u003eS. aureus\u003c/em\u003e CFUs in the presence of \u003cem\u003eC. striatum\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Interestingly, our patient with \u003cem\u003eS. aureus\u003c/em\u003e and \u003cem\u003eC. amycolatum\u003c/em\u003e infection had a chronic, exuding wound from an infected vascular graft, suggesting that \u003cem\u003eS. aureus\u003c/em\u003e may shift toward a more commensal behaviour in the presence of C. \u003cem\u003eamycolatum\u003c/em\u003e [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWe quantified the inhibitory effect of \u003cem\u003eE. coli\u003c/em\u003e on \u003cem\u003eC. glabrata\u003c/em\u003e, which aligns with existing literature demonstrating \u003cem\u003eE. coli's\u003c/em\u003e inhibitory effects on various \u003cem\u003eCandida\u003c/em\u003e species. Bandara et al. showed that \u003cem\u003eE. coli\u003c/em\u003e secretory products significantly inhibited biofilm formation in six \u003cem\u003eCandida\u003c/em\u003e spp. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, Cabral et al. reported a fungicidal effect from both \u003cem\u003eE. coli\u003c/em\u003e co-culture and \u003cem\u003eE. coli\u003c/em\u003e-conditioned media on \u003cem\u003eC. albicans\u003c/em\u003e, while \u003cem\u003eE. coli\u003c/em\u003e\u0026rsquo;s growth remained unaffected, suggesting the secretion of a fungicidal element [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Although no studies have specifically examined the interaction between \u003cem\u003eK. aerogenes\u003c/em\u003e and \u003cem\u003eC. glabrata\u003c/em\u003e, research involving caterpillar larvae suggests a synergistic pathogen-pathogen interaction in the biofilm of \u003cem\u003eK. aerogenes\u003c/em\u003e and \u003cem\u003eC. albicans\u003c/em\u003e [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough we primarily observed antagonistic interactions between isolated strains, patients with polymicrobial infections experienced higher mortality rates, even after adjustment for age, graft location, and comorbidities. Several factors may contribute to this increased mortality risk, including the need for more toxic combination therapies, and complex interactions at both the microbe-microbe and microbe-host levels. Pathogen competition could result in persistent low-grade infections that are difficult to eradicate and may lead to altered inflammatory responses.\u003c/p\u003e\u003cp\u003eOur study has several strengths, including the prospective enrolment of patients with incident VGEI and the use of patient-derived bacterial strains. To the best of our knowledge, this is the largest analysis of patient characteristics and outcomes in polymicrobial VGEI. We assessed the fitness of a wide range of pathogens from polymicrobial infections using solid agar to replicate the graft infection environment. By comparing mono- and co-cultures, we ruled out nutrient limitations as a factor affecting growth. Additionally, QFA enabled the measurement of full growth curves, including culture doubling time. Notably, QFA is cost-effective compared to other methods as it does not require fluorescence staining or microscopy and eliminates the need for time-consuming CFU-counting [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOur study has limitations. In the fitness analysis, we focused on a random subset of patient samples from a specific timeframe, without accounting for patient-specific factors. While the microbiological rationale for including diverse pathogens is clear, the clinical implications of observed fitness changes remain speculative. Our sampling strategy captured only a single timepoint in the infection process, limiting QFA's ability to discern the longitudinal impact of pathogen interactions. Despite these limitations, our approach provides qualitative insights into polymicrobial interactions. A more definitive understanding of the clinical effects of polymicrobial VGEI would require larger, in-depth epidemiological studies.\u003c/p\u003e\u003cp\u003eIn conclusion, our study establishes an analytical framework and an affordable method for quantifying polymicrobial interactions, while also paving the way for future research into the complex relationship between polymicrobial infections and clinical outcomes. Expanding this study to a larger scale with more patient samples and time points could provide valuable quantitative data. Future research using QFA has the potential to offer a deeper insight into pathogen interactions and their impact on clinical outcomes. Understanding the \u003cem\u003ein vitro\u003c/em\u003e behaviour of pathogens may ultimately inform personalized patient management strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eACKNOWLEDGEMENTS AND FUNDING SOURCES\u003c/h2\u003e\n\u003cp\u003eThis work was supported by the University of Zurich, Clinical Research Priority Program \u0026ldquo;Precision Medicine for Bacterial Infections\u0026rdquo; (to ASZ, BH, SDB) and the Swiss National Science Foundation grants #31003A_176252 (to ASZ); # 32003B_219351/1 (to BH); # 211422 (to SDB).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eConceptualization and Methodology: CIP, JE, BL, CTA, PMF, SDB, BH\u003c/p\u003e\n\u003cp\u003eInvestigation: CIP, JE, CTA, AT\u003c/p\u003e\n\u003cp\u003eSoftware: JB, PMF\u003c/p\u003e\n\u003cp\u003eData Curation: CIP, JE, JB, BH\u003c/p\u003e\n\u003cp\u003eFormal analysis: BL, JB, JBP\u003c/p\u003e\n\u003cp\u003eResources: BR, PMF, ASZ, SDB, BH\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; original draft: CIP, JE\u003c/p\u003e\n\u003cp\u003eWriting \u0026ndash; Review \u0026amp; Editing: CIP, JE, BL, JB, AT, BR, PMF, ASZ, SDB, BH\u003c/p\u003e\n\u003cp\u003eApproval of submitted version of the manuscript: all authors.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConflicts of interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization and Methodology: CIP, JE, BL, CTA, PMF, SDB, BHInvestigation: CIP, JE, CTA, ATSoftware: JB, PMFData Curation: CIP, JE, JB, BHFormal analysis: BL, JB, JBPResources: BR, PMF, ASZ, SDB, BHWriting \u0026ndash; original draft: CIP, JEWriting \u0026ndash; Review \u0026amp; Editing: CIP, JE, BL, JB, AT, BR, PMF, ASZ, SDB, BHApproval of submitted version of the manuscript: all authors.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWilson WR, Bower TC, Creager MA, Amin-Hanjani S, O\u0026rsquo;Gara PT, Lockhart PB, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement from the American Heart Association. vol. 134. 2016. https://doi.org/10.1161/CIR.0000000000000457.\u003c/li\u003e\n\u003cli\u003eChakf\u0026eacute; N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, et al. Editor\u0026rsquo;s Choice \u0026ndash; European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. European Journal of Vascular and Endovascular Surgery 2020;59:339\u0026ndash;84. https://doi.org/10.1016/j.ejvs.2019.10.016.\u003c/li\u003e\n\u003cli\u003eKhalid W, Puges M, Stenson K, Cazanave C, Ducasse E, Caradu C, et al. Referral Centre Experience with Infected Abdominal Aortic Endograft Explantation. European Journal of Vascular and Endovascular Surgery 2023;65:149\u0026ndash;58. https://doi.org/10.1016/j.ejvs.2022.10.003.\u003c/li\u003e\n\u003cli\u003eSmeds MR, Duncan AA, Harlander-Locke MP, Lawrence PF, Lyden S, Fatima J, et al. Treatment and outcomes of aortic endograft infection. J Vasc Surg 2016;63:332\u0026ndash;40. https://doi.org/10.1016/j.jvs.2015.08.113.\u003c/li\u003e\n\u003cli\u003eGavali H, Mani K, Furebring M, Olsson KW, Lindstr\u0026ouml;m D, S\u0026ouml;relius K, et al. Editor\u0026rsquo;s Choice \u0026ndash; Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study. European Journal of Vascular and Endovascular Surgery 2021;62:918\u0026ndash;26. https://doi.org/10.1016/j.ejvs.2021.09.033.\u003c/li\u003e\n\u003cli\u003eSixt T, Aho S, Chavanet P, Moretto F, Denes E, Mahy S, et al. Long-term Prognosis Following Vascular Graft Infection: A 10-Year Cohort Study. Open Forum Infect Dis 2022;9. https://doi.org/10.1093/ofid/ofac054.\u003c/li\u003e\n\u003cli\u003eStockschl\u0026auml;der L, Margaryan D, Omran S, Schomaker M, Greiner A, Trampuz A. Characteristics and Outcome of Vascular Graft Infections: A Risk Factor and Survival Analysis. Open Forum Infect Dis 2024;11. https://doi.org/10.1093/ofid/ofae271.\u003c/li\u003e\n\u003cli\u003eTan TL, Kheir MM, Tan DD, Parvizi J. Polymicrobial Periprosthetic Joint Infections. J Bone Joint Surg 2016;98:2082\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eZheng C, Zhang S, Chen Q, Zhong L, Huang T, Zhang X, et al. Clinical characteristics and risk factors of polymicrobial Staphylococcus aureus bloodstream infections. Antimicrob Resist Infect Control 2020;9:1\u0026ndash;11. https://doi.org/10.1186/s13756-020-00741-6.\u003c/li\u003e\n\u003cli\u003ePeric\u0026agrave;s JM, Llopis J, Athan E, Hern\u0026aacute;ndez-Meneses M, Hannan MM, Murdoch DR, et al. Prospective Cohort Study of Infective Endocarditis in People Who Inject Drugs. J Am Coll Cardiol 2021;77:544\u0026ndash;55. https://doi.org/10.1016/j.jacc.2020.11.062.\u003c/li\u003e\n\u003cli\u003eDuggan J, Peters A, Halbert S, Antevil J, Trachiotis GD. Microbiology of Infective Endocarditis in United States Veterans \u0026mdash; Association Between Causative Organism and Short- and Long-Term Outcomes. Heart Surgery Forum 2023;26:E791\u0026ndash;9. https://doi.org/10.59958/hsf.6717.\u003c/li\u003e\n\u003cli\u003eHardy BL, Bansal G, Hewlett KH, Arora A, Schaffer SD, Kamau E, et al. Antimicrobial Activity of Clinically Isolated Bacterial Species Against Staphylococcus aureus. Front Microbiol 2020;10. https://doi.org/10.3389/fmicb.2019.02977.\u003c/li\u003e\n\u003cli\u003eRamsey MM, Freire MO, Gabrilska RA, Rumbaugh KP, Lemon KP. Staphylococcus aureus Shifts toward commensalism in response to corynebacterium species. Front Microbiol 2016;7. https://doi.org/10.3389/fmicb.2016.01230.\u003c/li\u003e\n\u003cli\u003eYadav V, Mandhan R, Pasha Q, Pasha S, Katyal A, Chhillar AK, et al. An antifungal protein from Escherichia coli. J Med Microbiol 2007;56:637\u0026ndash;44. https://doi.org/10.1099/jmm.0.46973-0.\u003c/li\u003e\n\u003cli\u003eFrey PM, Baer J, Bergada-Pijuan J, Lawless C, B\u0026uuml;hler PK, Kouyos RD, et al. Quantifying Variation in Bacterial Reproductive Fitness: a High-Throughput Method. MSystems 2021;6:1\u0026ndash;13. https://doi.org/10.1128/msystems.01323-20.\u003c/li\u003e\n\u003cli\u003eCharlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373\u0026ndash;83. https://doi.org/10.1016/0021-9681(87)90171-8.\u003c/li\u003e\n\u003cli\u003eB\u0026auml;r J, Boumasmoud M, Mairpady Shambat S, Vulin C, Huemer M, Schweizer TA, et al. Quantification of within-patient Staphylococcus aureus phenotypic heterogeneity as a proxy for the presence of persisters across clinical presentations. Clinical Microbiology and Infection 2022;28:1022.e1-1022.e7. https://doi.org/10.1016/j.cmi.2022.01.021.\u003c/li\u003e\n\u003cli\u003eJ. Bergada. Bacolonyzer. GitHub 2019. https://github.com/judithbergada/bacolonyzer (accessed November 18, 2024).\u003c/li\u003e\n\u003cli\u003eWickham H, Averick M, Bryan J, Chang W, McGowan L, Fran\u0026ccedil;ois R, et al. Welcome to the Tidyverse. J Open Source Softw 2019;4:1686. https://doi.org/10.21105/joss.01686.\u003c/li\u003e\n\u003cli\u003eBates D, M\u0026auml;chler M, Zurich E, Bolker BM, Walker SC. Fitting linear mixed-effects models using lme4. n.d.\u003c/li\u003e\n\u003cli\u003eLenth R (2024). emmeans: Estimated Marginal Means, aka Least-Squares Means. R package version 1.10.6, https://rvlenth.github.io/emmeans/ n.d.\u003c/li\u003e\n\u003cli\u003eBrugger SD, Eslami SM, Pettigrew MM, Escapa IF, Henke MT, Kong Y, et al. Dolosigranulum pigrum Cooperation and Competition in Human Nasal Microbiota. MSphere 2020;5. https://doi.org/10.1128/msphere.00852-20.\u003c/li\u003e\n\u003cli\u003eVan Hemelrijck M, Sromicki J, Husmann L, Rancic Z, Hasse B, Carrel TP. Vascular graft infections. Vessel Plus 2022;6. https://doi.org/10.20517/2574-1209.2022.18.\u003c/li\u003e\n\u003cli\u003eCaradu C, Puges M, Cazanave C, Martin G, Ducasse E, B\u0026eacute;rard X, et al. Outcomes of patients with aortic vascular graft and endograft infections initially contra-indicated for complete graft explantation. J Vasc Surg 2022;76:1364-1373.e3. https://doi.org/10.1016/j.jvs.2022.05.007.\u003c/li\u003e\n\u003cli\u003eZhang G, Zhang N, Xu J, Yang T, Yin H, Cai Y. Efficacy and safety of vancomycin for the treatment of Staphylococcus aureus bacteraemia: a systematic review and meta-analysis. Int J Antimicrob Agents 2023;62:106946. https://doi.org/10.1016/J.IJANTIMICAG.2023.106946.\u003c/li\u003e\n\u003cli\u003eYan M, Pamp SJ, Fukuyama J, Hwang PH, Cho DY, Holmes S, et al. Nasal microenvironments and interspecific interactions influence nasal microbiota complexity and S. aureus carriage. Cell Host Microbe 2013;14:631\u0026ndash;40. https://doi.org/10.1016/j.chom.2013.11.005.\u003c/li\u003e\n\u003cli\u003eHuang S, Hon K, Bennett C, Hu H, Menberu M, Wormald PJ, et al. Corynebacterium accolens inhibits Staphylococcus aureus induced mucosal barrier disruption. Front Microbiol 2022;13. https://doi.org/10.3389/fmicb.2022.984741.\u003c/li\u003e\n\u003cli\u003eBandara HM, Cheung BPK, Watt RM, Jin LJ, Samaranayake LP. Secretory products of Escherichia coli biofilm modulate Candida biofilm formation and hyphal development. J Investig Clin Dent 2013;4:186\u0026ndash;99. https://doi.org/10.1111/jicd.12048.\u003c/li\u003e\n\u003cli\u003eCabral DJ, Penumutchu S, Norris C, Morones-Ramirez JR, Belenky P. Microbial competition between escherichia coli and candida albicans reveals a soluble fungicidal factor. Microbial Cell 2018;5:249\u0026ndash;55. https://doi.org/10.15698/mic2018.05.631.\u003c/li\u003e\n\u003cli\u003eMaione A, de Alteriis E, Carraturo F, Galdiero S, Falanga A, Guida M, et al. The membranotropic peptide gh625 to combat mixed candida albicans/klebsiella pneumoniae biofilm: Correlation between in vitro anti-biofilm activity and in vivo antimicrobial protection. Journal of Fungi 2021;7:1\u0026ndash;15. https://doi.org/10.3390/jof7010026.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Baseline characteristics overall and stratified by poly- versus monomicrobial infections (n=227)\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"602\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u003cstrong\u003eAll\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eVGEI episodes\u003c/strong\u003e\u003cbr\u003en=227\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u003cstrong\u003ePolymicrobial\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eVGEI episodes\u003c/strong\u003e\u003cbr\u003en=81\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u003cstrong\u003eMonomicrobial\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eVGEI episodes\u003c/strong\u003e\u003cbr\u003en=146\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u003cstrong\u003e\u003cem\u003eP-\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003evalue\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eFemale sex\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e49 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (21.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e15 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (18.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e34 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (23.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.501\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u0026nbsp;\u003cbr\u003emedian [years] (IQR)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e68 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (60-76)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e68 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (60-75)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e68.5 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(60-76)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.673\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003cbr\u003emedian [kg/m\u003csup\u003e2\u003c/sup\u003e] (IQR)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e25.9 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(23-28.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e26.2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(23.3-29)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e25.7 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(23-28.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.632\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003csup\u003e1\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.155\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Never, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e67 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (30.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (22.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e49 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (34.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Current, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e62 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (27.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e26 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (32.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e36 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (25.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Former, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e93 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (41.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e36 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (45.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e57 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (40.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eAlcohol consumption\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e,\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.662\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; None/ light n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e199 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (88.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e70 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (87.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e129 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (88.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mod/severe, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e26 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (11.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e10 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (12.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e16 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (11.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eCCI\u003c/strong\u003e, median (IQR)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(1-4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(1-3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(1-4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.922\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e144 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (63.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e57 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (70.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e87 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (59.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.117\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eArterial hypertension\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e176 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (77.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e65 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (80.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e111 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (76.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.230\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e48 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (21.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (22.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e30 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (20.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.865\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eDiabetes mellitus with end-organ damage\u003c/strong\u003e\u003csup\u003e3\u003c/sup\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e14 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (6.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e7 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(8.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e7 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(4.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.262\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003ePrevious myocardial infarction\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e39 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (17.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e13 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (16.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e26 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (17.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.855\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eCongestive heart failure\u003c/strong\u003e,\u0026nbsp;\u003cbr\u003en (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e24 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (10.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e6 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(7.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (12.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.367\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003ePeripheral arterial disease\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e85 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (37.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e42 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (51.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e43 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (29.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eCerebrovascular disease\u003c/strong\u003e,\u0026nbsp;\u003cbr\u003en (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e51 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (22.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e14 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (17.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e37 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (25.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.186\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eAny malignancy within last 5 years\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e41 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (18.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (23.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e22 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (15.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.149\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eLocation of VGEI\u003c/strong\u003e, n (%)\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intracavitary \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; abdominal\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e82 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (36.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e30 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (37.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e52 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (35.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Intracavitary \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; thoracic\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e81 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (35.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e15 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (18.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e66 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (45.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Extracavitary\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e64 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (28.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e36 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (44.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e28 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (19.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eRoute\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of VGEI\u003c/strong\u003e, n (%)\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Perioperative\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e62 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (27.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e32 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (39.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e30 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (20.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Hematogenous\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e62 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (27.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e9 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(11.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e53 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (36.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cem\u003ePer continuitatem\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e82 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (36.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e38 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (46.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e44 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (30.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mycotic\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e21 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (9.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e2 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(2.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e19 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (13.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eFistula development\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e59 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (26.0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e33 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (40.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e26 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (17.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eGraft insertion in an infected site\u003c/strong\u003e, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e54 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (23.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e18 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (22.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e36 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (24.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e0.746\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003ePathogens\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;isolated\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Anaerobes, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e38 \u0026nbsp;(16.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e27 \u0026nbsp;(33.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e11 \u0026nbsp;(7.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Fungi, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e20 \u0026nbsp;(8.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e16 \u0026nbsp;(19.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e4 \u0026nbsp;(2.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Gram-negative, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e70 \u0026nbsp;(30.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e50 \u0026nbsp;(61.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e20 \u0026nbsp;(13.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Gram-positive, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e140 \u0026nbsp;(61.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e66 \u0026nbsp;(81.5)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e74 \u0026nbsp;(50.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mycobacteria, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e1 \u0026nbsp;(0.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e1 \u0026nbsp;(1.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e0 (0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mycoplasma, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e2 \u0026nbsp;(0.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e0 (0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e2 \u0026nbsp;(1.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Culture-neg., n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e35 \u0026nbsp;(15.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u003cstrong\u003eSurgical treatment\u0026nbsp;\u003c/strong\u003e\u003csup\u003e4\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026lt;0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Complete excision of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; graft, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e61 \u0026nbsp;(26.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e24 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (29.6)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e37 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (25.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Partial excision of \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; graft, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e13 \u0026nbsp;(5.7)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e6 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(7.4)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e7 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(4.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Debridement, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e70 \u0026nbsp;(30.8)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e38 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (46.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e32 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (21.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Endovascular repair,\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e3 \u0026nbsp;(1.3)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(0)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e3 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(2.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 183px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; None, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e80 \u0026nbsp;(35.2)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e13 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (16.1)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e67 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (45.9)\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eNotes\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e-values calculated with Fisher\u0026rsquo;s exact test for categorical variables, Wilcoxon rank-sum test for continuous variables.\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Missing values for smoking status for 5 episodes, total n=222\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Alcohol consumption was stratified based on the World Health Organization\u0026rsquo;s definition of light, moderate and severe use. Missing values for alcohol consumption for 2 episodes, total n=225\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e End-organ damage defined as: retinopathy, neuropathy, nephropathy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Maximal intervention within 180 days of VGEI diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: BMI, body mass index; CCI, Charlson Comorbidity Index; IQR, interquartile range; mod, moderate; neg, negative; VGEI, Vascular graft/endograft infection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Results of unadjusted and adjusted Cox proportional hazards models for death\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29px;\"\u003e\u003cstrong\u003eUnadjusted\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 29px;\"\u003e\u003cstrong\u003eAdjusted \u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eMonomicrobial\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003ePolymicrobial\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e2.42\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e1.31-4.49\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.005\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e2.91\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e1.56-5.42\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.001\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.65\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.27-1.56\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.333\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.56\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.22-1.48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.243\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eAge, per 10 years\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.84\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e1.24-2.72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.003\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e2.08\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e1.28-3.40\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.003\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026lt;25 kg/m\u003csup\u003e2\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; 25-30 kg/m\u003csup\u003e2\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.77\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.38-1.57\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.480\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.74\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.36-1.50\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.405\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026gt;30 kg/m\u003csup\u003e2\u003c/sup\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.15\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.53-2.50\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.714\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.34\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.58-3.07\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.493\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eCCI \u0026gt;4\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.87\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.94-3.72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.075\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.85\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.92-3.74\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.086\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Intracavitary abdominal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Intracavitary thoracic\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.87\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.41-1.83\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.706\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.68-3.41\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.302\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Extracavitary\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.26\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.60-2.62\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.546\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.05\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.48-2.32\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.900\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Never\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Past\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.18\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.59-2.38\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.641\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Current\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.62\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.26-1.48\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.282\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eActive malignancy \u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.67\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.85-3.27\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.138\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eCoronary heart disease or heart failure\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.73\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.90-3.32\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.102\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e2.12\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e1.08-4.13\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.028\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003ePeripheral arterial disease\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.04\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.55-1.96\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.912\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eFistula development\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e0.76\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.36-1.59\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.469\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eGraft insertion in an infected site\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.51\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.77-2.97\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.232\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u003cstrong\u003eMaximal operation within 180 days\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; None\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003eref\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Endovascular repair\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e4.23\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.45-39.4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.206\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Debridement\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.64\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.74-3.63\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.220\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Partial graft removal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.35\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.32-5.77\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.682\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\u0026nbsp; \u0026nbsp; Complete graft removal\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 7px;\"\u003e1.90\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e0.84-4.31\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e0.126\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: BMI, body mass index; CCI, Charlson Comorbidity Index; CI, Confidence interval; HR, Hazards ratio.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNotes\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTotal n=227.\u003c/p\u003e\n\u003cp\u003e1 Adjusted for sex, age, BMI, CCI, graft location.\u003c/p\u003e\n\u003cp\u003e2 Defined as: Malignancy diagnosed or treated within the last 5 years (solid or hematologic).\u003c/p\u003e\n\u003cp\u003eTable 3: Summary of clinical isolates and corresponding clinical information of 5 patients with polymicrobial VGEI\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"905\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\u003cstrong\u003ePatient Nr.\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cstrong\u003eBacterial species\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003e\u003cstrong\u003eIVDU\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\u003cstrong\u003eSample material\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\u003cstrong\u003eRemoval of prosthesis\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\u003cstrong\u003eICU stay\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\u003cstrong\u003eBacteraemia (days)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\u003cstrong\u003eAntibiotic treatment\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\u003cstrong\u003eDeath\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eP1\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cem\u003eC. amycolatum\u003c/em\u003e\u003cbr\u003e\u003cem\u003eS. aureus\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003eM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e60\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003eDeep wound tissue\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003eNone\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003eTZP\u003cbr\u003eVA\u003cbr\u003eDAP\u003cbr\u003eCIP\u003cbr\u003eMTZ\u003cbr\u003eCN\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eP2\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003cbr\u003e\u003cem\u003eE. coli\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003eM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e72\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003eGraft prosthesis \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003eNone\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003eCAS\u003cbr\u003eTZP\u003cbr\u003eMEM\u003cbr\u003eDAP\u003cbr\u003eVA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eP3\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cem\u003eK. aerogenes\u003c/em\u003e\u003cbr\u003e\u003cem\u003eC. glabrata\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003eM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e53\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003eDeep wound tissue\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003eYes (10)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003eAMC\u003cbr\u003eVA\u003cbr\u003eCIP\u003cbr\u003eOX\u003cbr\u003eDAP\u003cbr\u003eCN\u003cbr\u003eISA\u003cbr\u003eSXT\u003cbr\u003eRA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eP4\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cem\u003eE. faecalis\u003c/em\u003e\u003cbr\u003e\u003cem\u003eC. amycolatum\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003eM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e51\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003eDeep wound tissue\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003eNone\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003eAMC\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eP5\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\u003cem\u003eS. epidermidis\u003c/em\u003e\u003cbr\u003e\u003cem\u003eE. cloacae\u003c/em\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003eM\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40px;\"\u003e74\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 52px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003eDeep wound tissue\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003eNo\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003eMEM\u003cbr\u003eVA\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003eNo\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations\u003c/strong\u003e: M, Male; IVDU, Intravenous drug use; ICU, intensive care unit; \u003cem\u003eC. amycolatum , Corynebacterium amycolatum; C. glabrata, Candida glabrata; E. cloacae, Enterobacter cloacae; E. faecalis, Enterococcus faecalis; E. coli, Escherichia coli; K. aerogenes, Klebsiella aerogenes; S. aureus, Staphylcococcus aureus; E. epidermidis, Staphylococcus epidermidis\u003c/em\u003e; AMC, Amoxicillin-clavulanic acid; CAS, Caspofungin; CIP, Ciprofloxacin; SXT, Trimethoprim/Sulfamethoxazol; DAP, Daptomycin; OX, Flucloxacillin; CN, Gentamicin; ISA, Isavuconazol; MTZ, Metronidazol; MEM, Meropenem; TAZ, Piperacillin/Tazobactam; RA, Rifampicin; VA, Vancomycin.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"prosthetic vascular graft infections, quantitative fitness analysis (QFA), polymicrobial infections, microbe-microbe interactions","lastPublishedDoi":"10.21203/rs.3.rs-7579415/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7579415/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e\u003cp\u003eVascular graft/endograft infections (VGEI) are difficult-to-treat and associated with high morbidity and mortality. Up to 40% of VGEI are polymicrobial, complicating clinical management. This study investigates microbial interactions and their impact on clinical outcomes.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe analyzed patient characteristics and survival in poly- versus monomicrobial infections from the VASGRA cohort, a Swiss prospective observational study. Kaplan-Meier analysis and Cox proportional hazards models were used to assess survival. Furthermore, a subset of patient-derived bacterial strains underwent Quantitative Fitness Analysis (QFA) to quantify changes in fitness in mono- and polymicrobial conditions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eAmong 227 VGEI episodes, 81 (35.7%) were polymicrobial. The overall survival rate was 84.4% at two years and 77.5% at five years, with polymicrobial infections associated with lower survival (logrank ranktest p\u0026thinsp;=\u0026thinsp;0.004). Multivariable analyses confirmed that polymicrobial infections (adjusted HR\u0026thinsp;=\u0026thinsp;2.91, 95% CI: 1.56\u0026ndash;5.42, p\u0026thinsp;=\u0026thinsp;0.001), age per 10 years older (adjusted HR\u0026thinsp;=\u0026thinsp;2.08, 95% CI: 1.28\u0026ndash;3.40, p\u0026thinsp;=\u0026thinsp;0.003), and diabetes mellitus (adjusted HR\u0026thinsp;=\u0026thinsp;2.12, 95% CI: 1.08\u0026ndash;4.13, p\u0026thinsp;=\u0026thinsp;0.028), were independent risk factors for increased mortality. QFA of five strain pairs revealed diverse interaction patterns among pathogens, ranging from complete inhibition to enhanced growth in co-culture.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003ePolymicrobial infections, along with older age and diabetes mellitus, were identified as independent risk factors for increased mortality in VGEI patients. QFA revealed diverse bacterial interactions, highlighting the complexity of polymicrobial environments in VGEI.\u003c/p\u003e","manuscriptTitle":"Clinical and Microbial Insights into Polymicrobial Vascular Graft Infections: A Prospective Observational Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 10:20:15","doi":"10.21203/rs.3.rs-7579415/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-23T08:22:36+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"176770431263894204755276718681270834744","date":"2025-11-29T06:12:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-26T15:13:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260045510381872491008719829217407157885","date":"2025-09-18T07:25:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-12T06:19:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-12T04:19:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-12T04:00:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Infection","date":"2025-09-10T06:25:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"fbe1df86-f1e9-4e2d-9bdd-be7b261ebe03","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-30T16:19:09+00:00","versionOfRecord":{"articleIdentity":"rs-7579415","link":"https://doi.org/10.1007/s15010-026-02775-1","journal":{"identity":"infection","isVorOnly":false,"title":"Infection"},"publishedOn":"2026-03-26 16:11:24","publishedOnDateReadable":"March 26th, 2026"},"versionCreatedAt":"2025-09-22 10:20:15","video":"","vorDoi":"10.1007/s15010-026-02775-1","vorDoiUrl":"https://doi.org/10.1007/s15010-026-02775-1","workflowStages":[]},"version":"v1","identity":"rs-7579415","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7579415","identity":"rs-7579415","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}