Wu Shye-Jao, Sun Shen, Tan Yu-Hern, Chien Chen-Yen
Division of Cardiovascular Surgery, Departments of Surgery, MacKay Memorial Hospital, Taipei, Taiwan.
MacKay Medical College, New Taipei, Taiwan.
Antimicrob Resist Infect Control. 2024 Oct 1;13(1):116. doi: 10.1186/s13756-024-01477-3.
Some patients with an infective native aortic aneurysm (INAA) develop an aortic vascular graft or endograft infection (VGEI) even after successful open surgical repair or endovascular intervention. The aim of the systematic review and meta-analysis performed herein was to compare the clinical outcomes of different surgical and antibiotic treatment strategies.
We systematically searched PubMed, MEDLINE, EMBASE and Web of Science. The keywords used for the search were "mycotic aortic aneurysm", "infected aortic aneurysm", "infective native aortic aneurysm", "antibiotics", "surgery", and "endovascular". The search was limited to articles written in English and to studies involving humans. Articles published before 2000 were excluded. Case reports and review articles were excluded.
Of the 524 studies retrieved from our search of the databases, 47 articles were included in this study. Among the 47 articles (1546 patients, 72.8% of whom were male) retrieved, five articles were excluded from the subgroup analysis because the data concerning open surgical repair and endovascular intervention could not be separated. The remaining 42 articles included a total of 1179 patients who underwent open surgical repair (622 patients) or endovascular intervention (557 patients) for INAA. There was a statistically significant difference (p = 0.001) in the pooled in-hospital mortality rate between the open surgical repair group (13.2%, 82/622) and the endovascular intervention group (7.2%, 40/557). However, there was a statistically significant difference (p < 0.001) in the aortic VGEI rate between the open surgical repair group (5.4%). 29/540) and endovascular intervention (13.3%, 69/517) group. For patients who underwent open surgical repair, a lower rate of aortic vascular graft infection was associated with long-term antibiotic use (p = 0.005). For patients who underwent endovascular intervention, there was a trend of association (p = 0.071) between the lower rate of aortic endograft infection and lifelong antibiotic use.
Infective native aortic aneurysms are life-threatening. The pooled in-hospital mortality rate of the open surgical repair group was significantly higher than that of the endovascular intervention group, whereas the rate of the aortic VGEI in the open surgical repair group was significantly lower than that in the endovascular intervention group. Regardless of whether open surgical repair or endovascular intervention is performed, better long-term outcomes can be achieved with aggressive antibiotic treatment, which is especially important for patients who undergo endovascular intervention.
一些感染性原发性主动脉瘤（INAA）患者即使在成功进行开放手术修复或血管内介入治疗后仍会发生主动脉血管移植物或腔内移植物感染（VGEI）。本系统评价和荟萃分析的目的是比较不同手术和抗生素治疗策略的临床结果。
我们系统检索了PubMed、MEDLINE、EMBASE和科学网。搜索所用关键词为“霉菌性主动脉瘤”“感染性主动脉瘤”“感染性原发性主动脉瘤”“抗生素”“手术”和“血管内”。搜索仅限于用英文撰写的文章和涉及人类的研究。排除2000年以前发表的文章。排除病例报告和综述文章。
在我们检索数据库获得的524项研究中，本研究纳入了47篇文章。在检索到的47篇文章（1546例患者，其中72.8%为男性）中，5篇文章被排除在亚组分析之外，因为有关开放手术修复和血管内介入治疗的数据无法分开。其余42篇文章共纳入1179例因INAA接受开放手术修复（622例患者）或血管内介入治疗（557例患者）的患者。开放手术修复组（13.2%，82/622）和血管内介入治疗组（7.2%，40/557）的合并住院死亡率存在统计学显著差异（p = 0.001）。然而，开放手术修复组（5.4%，29/540）和血管内介入治疗组（13.3%，69/517）的主动脉VGEI发生率存在统计学显著差异（p < 0.001）。对于接受开放手术修复的患者，长期使用抗生素与较低的主动脉血管移植物感染率相关（p = 0.005）。对于接受血管内介入治疗的患者，较低的主动脉腔内移植物感染率与终身使用抗生素之间存在关联趋势（p = 0.071）。
感染性原发性主动脉瘤危及生命。开放手术修复组的合并住院死亡率显著高于血管内介入治疗组，而开放手术修复组的主动脉VGEI发生率显著低于血管内介入治疗组。无论进行开放手术修复还是血管内介入治疗，积极的抗生素治疗均可取得更好的长期效果，这对接受血管内介入治疗的患者尤为重要。
