Ernst C B, Campbell H C, Daugherty M E, Sachatello C R, Griffen W O
Ann Surg. 1977 Jun;185(6):626-33. doi: 10.1097/00000658-197706000-00003.
Eighty patients undergoing abdominal aortic aneurysmectomy were studied to identify sources of potential graft sepsis. All but one patient received perioperative antibiotics. Samples obtained from aneurysm contents in 78 and bowel bag fluid in 45 were cultured for organisms. Twelve of 78 (15%) aneurysm cultures and five of 45 (11%) intestinal bag cultures yielded bacterial growth. Sixteen patients had positive cultures from either source and one from both, an overall incidence of 20%. Forty-four patients had asymptomatic aneurysms, 23 had symptomatic aneurysms, and 13 had ruptured aneurysms. A significantly greater frequency of bacterial growth occurred from ruptured than from non-ruptured aneurysms (p less than 0.05). Two patients (2.5%) developed graft sepsis. Comparing survivors followed a minimum of 6 months in the positive and negative culture groups, the late graft sepsis rate was 10% and 2% respectively. Two heretofore not widely recognized sources for late graft sepsis were identified: aneurysmal contents and intestinal bag fluid. Reasons for difference between potential graft sepsis incidence of 20% and actual incidence of 2.5% may include antibiotic therapy, host resistance, or other unidentified variables. Routine culture of aneurysm and intestinal bag contents is recommended. Upon identifying bacterial growth from such sources, organism-specific antibiotics are required.
对80例行腹主动脉瘤切除术的患者进行研究，以确定潜在移植物感染的来源。除1例患者外，所有患者均接受围手术期抗生素治疗。对78例患者的动脉瘤内容物样本和45例患者的肠袋液样本进行微生物培养。78例动脉瘤样本中有12例（15%）培养出细菌，45例肠袋样本中有5例（11%）培养出细菌。16例患者的上述两种样本中至少有一种培养结果呈阳性，1例患者两种样本培养结果均为阳性，总体发生率为20%。44例患者为无症状性动脉瘤，23例为有症状动脉瘤，13例为破裂性动脉瘤。破裂性动脉瘤培养出细菌的频率显著高于未破裂动脉瘤（p<0.05）。2例患者（2.5%）发生移植物感染。对阳性和阴性培养组中至少随访6个月的幸存者进行比较，晚期移植物感染率分别为10%和2%。确定了两个此前未被广泛认识的晚期移植物感染来源：动脉瘤内容物和肠袋液。潜在移植物感染发生率为20%与实际发生率为2.5%之间存在差异的原因可能包括抗生素治疗、宿主抵抗力或其他未确定的变量。建议对动脉瘤和肠袋内容物进行常规培养。一旦从这些来源培养出细菌，就需要使用针对特定微生物的抗生素。
