Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.
Department of International Health and Tropical Medicine, Royal College of Surgeons of Ireland (RSCI), University of Medicine and Health Sciences, Dublin, Ireland.
BMC Infect Dis. 2021 Jul 9;21(1):670. doi: 10.1186/s12879-021-06373-4.
An estimated 1% of endovascular aneurysm repair (EVAR) devices become infected, carrying a high mortality rate. Surgical explantation is recommended and prognosis is guarded. This retrospective cohort analysis focuses on the role of outpatient parenteral antimicrobial therapy (OPAT) in the management of aortic vascular graft infections following EVAR.
Patients who received OPAT for aortic graft infections (AGI) following EVAR from 2014 to 2018 inclusive were identified using the OPAT database. Clinical, microbiological and radiological data were collected. Survivors were followed up for a median of 36 months (range 25-60) after first presentation with infection. Outcomes were assessed.
Eleven cases with 20 OPAT episodes were identified: 10/11 male, median age 76 (IQR 71-81). Median time to presentation was 7 months (range 0-81 months) after EVAR. OPAT lead to a 55% reduction in length of hospital stay. One patient had graft explantation; four others had temporising measures. Eight of 11 were alive a median of 36 months after presentation with infection, having had a median of 2 re-treatments on OPAT (range 1-3). Seven of the eight survivors were on continuous suppressive oral antimicrobials; three were also intermittently on intravenous antibiotics for flares of infection. Patient/ infection outcomes were cure (1/11), improved (7/11), failure (3/11).
AGI following EVAR usually presents in the first year after graft deployment. OPAT has an important peri-operative role in patients suitable for curative surgery. OPAT followed by oral suppressive antimicrobial therapy can be a feasible long-term treatment for non-curative management of AGI. Survival in our cohort was longer than expected, and OPAT was feasible despite the complexity of these infections. OPAT can avoid multiple and lengthy hospital admissions and maximise time at home and quality of life in this cohort with life-limiting infection.
据估计，1%的血管内动脉瘤修复（EVAR）装置会发生感染，死亡率很高。建议进行外科切除，预后不佳。本回顾性队列分析重点研究 EVAR 后主动脉血管移植物感染（AGI）患者接受门诊静脉内抗菌治疗（OPAT）的管理作用。
使用 OPAT 数据库确定 2014 年至 2018 年期间因 EVAR 后发生的主动脉移植物感染（AGI）接受 OPAT 的患者。收集临床、微生物学和影像学数据。对首次感染后中位随访 36 个月（范围 25-60）的存活者进行随访。评估结局。
确定了 11 例患者的 20 次 OPAT 治疗，其中 10/11 例为男性，中位年龄 76（IQR 71-81）。从 EVAR 到出现症状的中位时间为 7 个月（范围 0-81 个月）。OPAT 使住院时间缩短了 55%。1 例患者进行了移植物切除；另外 4 例进行了临时治疗。11 例患者中有 8 例在感染后中位 36 个月时存活，在 OPAT 治疗期间中位接受了 2 次再治疗（范围 1-3）。8 例存活者中有 7 例接受了连续口服抑菌抗生素治疗；3 例在感染发作时也间歇性静脉使用抗生素。患者/感染结局为治愈（1/11）、改善（7/11）、失败（3/11）。
EVAR 后 AGI 通常在移植物植入后的第一年出现。OPAT 在适合根治性手术的患者中具有重要的围手术期作用。在口服抑菌治疗后，对于 AGI 的非根治性管理，OPAT 可以作为一种可行的长期治疗方法。我们队列中的生存率高于预期，尽管这些感染复杂，但 OPAT 是可行的。OPAT 可以避免多次和长时间住院，并在这个具有生命限制感染的患者群体中最大限度地提高在家中的时间和生活质量。
