Reslan Ossama M, Ebaugh James L, Gupta Naren, Brecher Stephen M, Itani Kamal M F, Raffetto Joseph D
Department of Surgery, VA Boston HCS, West Roxbury, MA 02132, USA.
Ann Vasc Surg. 2012 Jul;26(5):732.e1-6. doi: 10.1016/j.avsg.2011.08.030.
Infected aortic aneurysms (IAAs) are rare but can have devastating outcomes, particularly if diagnosis and treatment are delayed. The incidence of IAA is between 0.65% and 2% of all aortic aneurysms. The disease has a poor prognosis because these aneurysms have an increased tendency to grow rapidly and to rupture, and patients often have severe comorbidities and coexisting sepsis. Typical microorganisms associated with IAA are Salmonella, Streptococci, and Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus (MRSA) continues to emerge as a cause of serious infections, but its association with IAA is extremely rare. We present a rare case of infected abdominal aortic aneurysm caused by hospital-acquired (HA) MRSA. This case adds another presentation to the clinical spectrum of HA MRSA infections, and it highlights the problems encountered in the choice of the therapy of serious HA or health care-acquired infections in an era of increasing MRSA infections. We will discuss the clinical spectrum of HA MRSA infections as well as the problems encountered in the management of IAA, and will review the relevant literature.
感染性主动脉瘤(IAAs)较为罕见,但可能导致灾难性后果,尤其是在诊断和治疗延迟的情况下。IAA在所有主动脉瘤中的发病率为0.65%至2%。该疾病预后较差,因为这些动脉瘤有迅速生长和破裂的倾向增加,且患者常伴有严重的合并症和并存的败血症。与IAA相关的典型微生物是沙门氏菌、链球菌和金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌(MRSA)持续成为严重感染的病因,但其与IAA的关联极为罕见。我们报告一例由医院获得性(HA)MRSA引起的感染性腹主动脉瘤罕见病例。该病例为HA MRSA感染的临床谱增添了另一种表现形式,并凸显了在MRSA感染日益增多的时代,治疗严重HA或医疗保健相关感染时在治疗选择上遇到的问题。我们将讨论HA MRSA感染的临床谱以及IAA管理中遇到的问题,并回顾相关文献。