Del Fabro Giovanni, Volpi Sara, Fumarola Benedetta, Migliorati Manuela, Bertelli Davide, Signorini Liana, Matteelli Alberto, Meschiari Marianna
Department of Infectious Diseases, Spedali Civili di Brescia, University of Brescia, 25123 Brescia, Italy.
Clinic of Infectious Diseases, University Hospital of Modena, 41124 Modena, Italy.
Microorganisms. 2023 Dec 6;11(12):2931. doi: 10.3390/microorganisms11122931.
Actinomycosis represents a challenging and under-reported complication of vascular surgery. Optimal management of spp. prosthetic vascular graft infection (PVGI) is highly uncertain because of the paucity of reports on this disease.
We conducted a retrospective case-series of -PVGI that occurred in the last five years in two major university hospitals in northern Italy. We searched for previously published cases in the scientific literature.
We report five original cases of spp. prosthetic vascular graft infection following aortic aneurysm repair. Our literature review retrieved eight similar cases. Most patients were immunocompetent males. Most infections were polymicrobial (11/13 cases), with a prevalence of involvement (3/13 cases were associated with. spp. infection). All cases had a late presentation (≥4 months from graft placement), with 61% associated with an aorto-enteric fistula. All patients received antibiotic therapy, but the duration was highly heterogeneous (from two weeks to life-long antibiotics). The patients without surgical revision experienced septic recurrences (2/13), permanent dysfunction (1/13), or a fatal outcome (2/13), while of the remainder who underwent vascular graft explant, six recovered completely and one developed a periprosthetic abscess. In two cases follow-up was not available.
This case-series aims to raise the diagnostic suspicion and to describe the current management of -PVGIs. We highlight a high heterogeneity in antibiotic duration, choice of the antibiotic regimen, and surgical management. Higher reporting rate is advisable to produce better evidence and optimize management of this rare complication of vascular surgery.
放线菌病是血管外科一种具有挑战性且报道不足的并发症。由于关于该疾病的报道匮乏，特定菌种人工血管移植物感染（PVGI）的最佳管理存在很大不确定性。
我们对意大利北部两家主要大学医院过去五年发生的特定菌种PVGI进行了回顾性病例系列研究。我们在科学文献中搜索先前发表的病例。
我们报告了5例主动脉瘤修复术后特定菌种人工血管移植物感染的原始病例。我们的文献回顾检索到8例类似病例。大多数患者为免疫功能正常的男性。大多数感染为多微生物感染（11/13例），特定菌种感染较为常见（3/13例与特定菌种感染相关）。所有病例均为晚期表现（移植物植入后≥4个月），61%与主动脉肠瘘相关。所有患者均接受了抗生素治疗，但疗程差异很大（从两周到终身使用抗生素）。未进行手术翻修的患者出现了败血症复发（2/13）、永久性功能障碍（1/13）或死亡（2/13），而其余接受血管移植物取出术的患者中，6例完全康复，1例发生了假体周围脓肿。2例患者没有随访信息。
本病例系列旨在提高诊断怀疑度，并描述特定菌种PVGIs的当前管理情况。我们强调在抗生素疗程、抗生素方案选择和手术管理方面存在高度异质性。建议提高报告率，以产生更好的证据并优化这种血管外科罕见并发症的管理。
