Departments of Surgery (Division of Vascular Surgery), Groningen, The Netherlands.
Internal Medicine (Division of Vascular Medicine), Groningen, The Netherlands.
Ann Vasc Surg. 2022 Aug;84:225-238. doi: 10.1016/j.avsg.2022.01.006. Epub 2022 Jan 31.
The existing literature on mycotic aortic aneurysm is scarce and focuses on treatment. This study evaluates the clinical characteristics, diagnostics, treatment and outcome of patients with a mycotic abdominal aortic aneurysm treated in a tertiary referral center.
A retrospective cohort study was conducted including all patients with a proven mycotic abdominal aortic aneurysm admitted between May 2010 and July 2020. Primary outcome was mortality and secondary outcome included complications such as vascular graft/endograft infection.
Twenty-four patients with a mycotic abdominal aortic aneurysm were included. Patients had a mean age of 68 ± 9 years and 20 (83%) were male. Thirteen patients (57%) had positive preoperative blood cultures. Streptococcus pneumoniae was most frequently isolated by blood culturing, pus, and vascular, or perivascular tissue cultures (17%). In 19 (83%) patients the mycotic abdominal aortic aneurysm was located infrarenally, in three (13%) patients suprarenally, and in one (4%) patient juxtarenally. Median follow-up was 20 (7-42) months. In 8 patients (33%) vascular graft and or endograft infection was diagnosed after surgical repair. Ten (42%) patients died during the follow-up period. The main causes of death were vascular graft/endograft infection-related (n = 4) and rupture of the mycotic abdominal aortic aneurysm (n = 3). No patient characteristics could be identified as predictive for mortality.
This study shows a large variation in presentation, diagnostic approaches, and surgical and antibiotic treatment of mycotic abdominal aortic aneurysm. The detailed information about the diagnostic approaches to this rare disease and its antibiotic and/or other treatment contributes to existing knowledge of mycotic abdominal aortic aneurysm. Because of the individual variation patients should be discussed in a multidisciplinary team with a vascular surgeon, infectious disease specialist, and clinical microbiologist.
现有的真菌性主动脉瘤文献稀少，主要集中在治疗方面。本研究评估了在三级转诊中心治疗的真菌性腹主动脉瘤患者的临床特征、诊断、治疗和结局。
本研究回顾性纳入了 2010 年 5 月至 2020 年 7 月期间确诊为真菌性腹主动脉瘤的所有患者。主要结局为死亡率，次要结局包括血管移植物/血管内移植物感染等并发症。
共纳入 24 例真菌性腹主动脉瘤患者。患者的平均年龄为 68±9 岁，20 例（83%）为男性。13 例（57%）患者术前血培养阳性。血培养、脓液和血管或血管周围组织培养最常分离出肺炎链球菌（17%）。19 例（83%）患者的真菌性腹主动脉瘤位于肾下，3 例（13%）患者位于肾上，1 例（4%）患者位于肾旁。中位随访时间为 20（7-42）个月。19 例患者术后诊断为血管移植物和/或血管内移植物感染。10 例（42%）患者在随访期间死亡。死亡的主要原因是血管移植物/血管内移植物感染相关（n=4）和真菌性腹主动脉瘤破裂（n=3）。没有患者特征可被确定为死亡的预测因素。
本研究显示真菌性腹主动脉瘤的表现、诊断方法以及手术和抗生素治疗存在较大差异。本研究详细介绍了这种罕见疾病的诊断方法及其抗生素和/或其他治疗方法，丰富了对真菌性腹主动脉瘤的认识。由于个体差异，患者应在多学科团队中进行讨论，团队成员包括血管外科医生、传染病专家和临床微生物学家。
