Sörelius Karl, Prendergast Bernard, Fosbøl Emil, Søndergaard Lars
Department of Vascular Surgery, Rigshospitalet, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Cardiology, St Thomas' Hospital, London, UK.
Ann Vasc Surg. 2020 Oct;68:536-541. doi: 10.1016/j.avsg.2020.05.059. Epub 2020 Jun 3.
The absence of recommendations for the systematic collection of microbiological specimens to help determine the management of infective native aortic aneurysms (INAAs) may lead to diagnostic difficulty and suboptimal antibiotic treatment. In this review, we attempt to establish recommendations in the field by identifying current strategies for the diagnosis and management of INAA and comparing them with those for infective endocarditis (IE).
A systematic literature review of Medline and ScienceDirect databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)methodology to identify guidelines for the management of INAA. These guidelines were scrutinized for recommendations concerning the procurement of microbiological specimens according to a defined protocol and involvement of specialists in infectious diseases and compared with current practice for IE.
Three guidelines were found to have sections dedicated to INAA. Of these, none provided any recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes. The guidelines from the American Heart Association recommend that patients with INAA should be managed by a team of specialists (including representation from the fields of infectious diseases and/or microbiology). Current guidelines for the investigation and management of IE provide detailed recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes, as well as the involvement of specialists in infectious medicine in multidisciplinary management.
This article emphasizes the absence of recommendations for the optimal diagnosis and management of patients with INAAs. While specific research is required to create evidence-based recommendations, application of strategies to identify microorganisms and multidisciplinary team management derived from the management of IE may be both safe and appropriate for the clinical management of this highly complex and heterogeneous group.
缺乏关于系统采集微生物标本以帮助确定感染性原发性主动脉瘤（INAAs）治疗方案的建议，可能导致诊断困难和抗生素治疗效果欠佳。在本综述中，我们试图通过确定目前INAAs的诊断和治疗策略，并将其与感染性心内膜炎（IE）的相关策略进行比较，来制定该领域的建议。
使用PRISMA（系统评价和Meta分析的首选报告项目）方法对Medline和ScienceDirect数据库进行系统的文献综述，以确定INAAs的治疗指南。根据既定方案，仔细审查这些指南中关于采集微生物标本的建议以及传染病专家的参与情况，并与IE的现行做法进行比较。
发现有三项指南设有专门针对INAAs的章节。其中，没有一项指南提供关于为诊断和治疗目的采集微生物标本的任何建议。美国心脏协会的指南建议，INAAs患者应由一组专家（包括传染病和/或微生物学领域的代表）进行治疗。目前IE的调查和治疗指南提供了关于为诊断和治疗目的采集微生物标本的详细建议，以及传染病专家参与多学科治疗的建议。
本文强调缺乏针对INAAs患者的最佳诊断和治疗建议。虽然需要开展具体研究以制定基于证据的建议，但应用从IE治疗中衍生出的识别微生物的策略和多学科团队管理方法，对于这一高度复杂且异质性群体的临床管理可能既安全又合适。
