Steed D L, Higgins R S, Pasculle A, Webster M W
Department of Surgery, University of Pittsburgh, School of Medicine, Pennsylvania 15261.
Cardiovasc Surg. 1993 Oct;1(5):494-8.
The significance of positive bacterial cultures from intraluminal thrombus in patients undergoing repair of abdominal aortic aneurysm remains controversial. Over the last 4 years, thrombus was cultured during aneurysm repair in 116 patients. All patients received cephalosporin antibiotic before and for 48 h after operation. Although none of the aneurysms appeared to be clinically infected, six patients (5.2%) had positive cultures. Four groups were identified based on the bacteria cultured: group I, coagulase-negative staphylococci, light growth (three patients); group II, coagulase-negative staphylococci, light growth and 'Streptococcus viridans' (one patient); group III, Bacillus sp., heavy growth (Gram-negative stain) (one patient); group IV, Clostridium perfringens, occasional growth (one patient). One of the six patients died during resection; the other five are alive without graft infection at 5-24 (mean 12) months after operation. The absence of graft infection suggests that positive cultures were not clinically significant or were adequately covered by the antibiotic prophylaxis. The incidence of positive cultures was lower than previously reported. Routine culture of aneurysm thrombus in the absence of clinical infection is probably not cost-effective.
腹主动脉瘤修复患者腔内血栓细菌培养阳性的意义仍存在争议。在过去4年中，对116例接受动脉瘤修复手术的患者的血栓进行了培养。所有患者在术前及术后48小时均接受头孢菌素类抗生素治疗。尽管所有动脉瘤在临床上均未表现出感染迹象，但有6例患者（5.2%）培养结果呈阳性。根据培养出的细菌分为四组：第一组，凝固酶阴性葡萄球菌，轻度生长（3例患者）；第二组，凝固酶阴性葡萄球菌，轻度生长及“草绿色链球菌”（1例患者）；第三组，芽孢杆菌属，大量生长（革兰氏阴性染色）（1例患者）；第四组，产气荚膜梭菌，偶尔生长（1例患者）。6例患者中有1例在切除术中死亡；其他5例患者术后5 - 24个月（平均12个月）存活，且移植物未发生感染。移植物未感染表明培养阳性在临床上无显著意义，或抗生素预防措施已充分覆盖。培养阳性的发生率低于先前报道。在无临床感染的情况下对动脉瘤血栓进行常规培养可能不具有成本效益。
