Montelione Nunzio, Menna Danilo, Sirignano Pasqualino, Capoccia Laura, Mansour Wassim, Speziale Francesco
Tex Heart Inst J. 2016 Oct 1;43(5):453-457. doi: 10.14503/THIJ-15-5265. eCollection 2016 Oct.
A 62-year-old man presented with fever, abdominal pain, and malaise 13 months after emergency endovascular aortic repair. Computed tomographic angiograms showed a periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was performed, involving endograft explantation and in situ aortic reconstruction. Cultures and the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae, resistant to colistin. Because of the sparse data on endograft infections caused by this pathogen, we placed the patient on an empiric double-carbapenem regimen for 4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of persistent or recurrent infection. We think that this is the first report of aortic endograft infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae.
一名62岁男性在急诊血管腔内主动脉修复术后13个月出现发热、腹痛和全身不适。计算机断层血管造影显示假体周围有液体和气体聚集，因此诊断为感染。进行了开放转换，包括取出血管内移植物并进行原位主动脉重建。培养物和取出的假体对产碳青霉烯酶肺炎克雷伯菌呈阳性，该菌对黏菌素耐药。由于关于这种病原体引起的血管内移植物感染的数据稀少，我们让患者接受了为期4周的经验性双碳青霉烯类治疗方案。21天后症状有所缓解。在第30天，我们置入了一个支架来治疗新出现的假性动脉瘤。三年后，患者没有持续或复发感染的迹象。我们认为这是首例由耐黏菌素、产碳青霉烯酶肺炎克雷伯菌引起的主动脉血管内移植物感染的报告。
