Ghellab Lilya, Melenotte Cléa, Million Matthieu, Leveille Laury, Thomas Pascal, Collart Frédéric, Raoult Didier
IRD, APHM, MEPHI, Aix-Marseille University, Marseille, France.
IHU Méditerranée Infection, 19-21 bd Jean Moulin, 13005, Marseille, France.
Eur J Clin Microbiol Infect Dis. 2020 May;39(5):1003-1010. doi: 10.1007/s10096-020-03816-9. Epub 2020 Jan 21.
Coxiella burnetii cardiovascular prosthetic infections are associated with high morbidity and mortality and represent a major health problem due to the lack of standardized management. We were confronted with a C. burnetii infection on Bentall-De Bono prosthesis characterized by a history of vascular infection with relapse that prompted us to screen for cases of C. burnetii on Bentall-De Bono vascular prosthesis monitored in our center. We screened patients between 1991 and 2019, from the French national reference center for Q fever. A microbiological criterion in addition to a lesional criterion was necessary to diagnose C. burnetii persistent vascular infection. Two thousand five hundred and eighty two patient were diagnosed with Coxiella burnetii infection and 160 patients with persistent C. burnetii vascular infection prosthesis, 95 of whom had a vascular prosthesis, including 12 with Bentall-De Bono prosthesis. Among patients with persistent C. burnetii prosthetic vascular infection, patients with Bentall-De Bono prostheses were significantly more prone to develop complications such as aneurysm, fistula, and abscess (62 versus 32%, two-sided Chi-square test, p = 0.04). All but one patient were treated with doxycycline and hydroxychloroquine for a mean (± standard deviation) period of 29.4 ± 13.6 months. Among the 12 patients, 5 had cardio-vascular complications, and 5 had prolonged antibiotherapy with doxycycline and hydroxychloroquine. Patients with C. burnetii vascular infection on Bentall-De Bono tend to be at high risk of developing complications (fistula, aneurysm, abscess, death). Surgery is rarely performed. Clinical, serological, and PET scanner imaging follow-up is recommended.
伯纳特柯克斯体心血管人工瓣膜感染与高发病率和死亡率相关，由于缺乏标准化管理，这已成为一个重大的健康问题。我们遇到了一例发生在本特-德博诺人工瓣膜上的伯纳特柯克斯体感染，其特征是血管感染病史且有复发情况，这促使我们对在我们中心监测的本特-德博诺血管人工瓣膜上的伯纳特柯克斯体病例进行筛查。我们对1991年至2019年期间来自法国Q热国家参考中心的患者进行了筛查。诊断伯纳特柯克斯体持续性血管感染除了要有病变标准外，还需要微生物学标准。2582例患者被诊断为伯纳特柯克斯体感染，160例患者患有伯纳特柯克斯体持续性血管感染人工瓣膜，其中95例有血管人工瓣膜，包括12例有本特-德博诺人工瓣膜。在患有伯纳特柯克斯体持续性人工血管感染的患者中，安装本特-德博诺人工瓣膜的患者发生动脉瘤、瘘管和脓肿等并发症的可能性明显更高（分别为62%和32%，双侧卡方检验，p = 0.04）。除1例患者外，所有患者均接受了多西环素和羟氯喹治疗，平均（±标准差）疗程为29.4±13.6个月。在这12例患者中，5例发生了心血管并发症，5例接受了多西环素和羟氯喹的延长抗生素治疗。安装本特-德博诺人工瓣膜且发生伯纳特柯克斯体血管感染的患者往往有发生并发症（瘘管、动脉瘤、脓肿、死亡）的高风险。很少进行手术。建议进行临床、血清学和PET扫描仪成像随访。
