Sörelius Karl, Wanhainen Anders, Furebring Mia, Mani Kevin
Department of Vascular Surgery, Rigshospitalet, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Ann Vasc Surg. 2022 Jan;78:112-122. doi: 10.1016/j.avsg.2021.06.039. Epub 2021 Sep 17.
The aim was to describe the microbiology of surgically treated infective native (mycotic) aortic aneurysms (INAAs), and associated survival and development of infection-related complications (IRCs).
Data were pooled from 2 nationwide studies on surgically treated patients with INAAs in Sweden, between 1994 - 2016. Patients were grouped and analyzed according to culture results: 1) Staphylococcus aureus, 2) Streptococcus species (sp.), 3) Salmonella sp., 4) Enterococcus sp., 5) Gram-negative intestinal bacteria, 6) Other sp. (all other species found in culture), and 7) Negative cultures.
A sum of 182 patients were included, mean age 71 years (standard deviation; SD: 8.9). The median follow-up was 50.3 months (range 0 - 360). 128 (70.3%) patients had positive blood and/or tissue culture; Staphylococcus aureus n = 38 (20.9%), Streptococcus sp. n = 37 (20.3%), Salmonella sp. n = 19 (10.4%), Enterococcus sp. n = 16 (8.8%), Gram-negative intestinal bacteria n = 6, (3.3%), Other sp. n = 12 (6.6%) and Negative cultures n = 54 (29.7%). The estimated survival for the largest groups at 2-years after surgery was: Staphylococcus aureus 62% (95% Confidence interval 53.9 - 70.1), Streptococcus sp. 74.7% (67.4 - 82.0), Salmonella sp. 73.7% (63.6 - 83.8), Enterococcus sp. 61.9% (49.6 - 74.2), and Negative cultures 89.8% (85.5 - 94.1), P = .051. There were 37 IRCs (20.3%), and 19 (51.4%) were fatal, the frequency was insignificant between the groups. The majority of IRCs, 30/37 (81%), developed during the first postoperative year.
In this assessment of microbiological findings of INAAs in Sweden, 50% of the pathogens were Staphylococcus aureus, Streptococcus sp., or Salmonella sp.. The overall 20%-frequency of IRCs, and its association with high mortality, motivates long-term antibiotic treatment regardless of microbial findings.
描述手术治疗的感染性原发性（霉菌性）主动脉瘤（INAAs）的微生物学情况，以及相关的生存率和感染相关并发症（IRCs）的发生情况。
汇总了1994年至2016年间瑞典两项关于手术治疗INAAs患者的全国性研究数据。根据培养结果对患者进行分组和分析：1）金黄色葡萄球菌，2）链球菌属，3）沙门氏菌属，4）肠球菌属，5）革兰氏阴性肠道细菌，6）其他菌属（培养中发现的所有其他菌属），7）培养结果为阴性。
共纳入182例患者，平均年龄71岁（标准差；SD：8.9）。中位随访时间为50.3个月（范围0至360个月）。128例（70.3%）患者血液和/或组织培养结果为阳性；金黄色葡萄球菌38例（20.9%），链球菌属37例（20.3%），沙门氏菌属19例（10.4%），肠球菌属16例（8.8%），革兰氏阴性肠道细菌6例（3.3%），其他菌属12例（6.6%），培养结果为阴性54例（29.7%）。术后2年时，最大组的估计生存率为：金黄色葡萄球菌62%（95%置信区间53.9 - 70.1），链球菌属74.7%（67.4 - 82.0），沙门氏菌属73.7%（63.6 - 83.8），肠球菌属61.9%（49.6 - 74.2），培养结果为阴性89.8%（85.5 - 94.1），P = 0.051。发生37例IRCs（20.3%），其中19例（51.4%）死亡，各组间发生率无显著差异。大多数IRCs，30/37（81%）在术后第一年发生。
在本次对瑞典INAAs微生物学结果的评估中，50%的病原体为金黄色葡萄球菌、链球菌属或沙门氏菌属。IRCs总体发生率为20%，且与高死亡率相关，这表明无论微生物学结果如何，都应进行长期抗生素治疗。
