The Microbiology of Infective Native Aortic Aneurysms in a Population-Based Setting

• DOI: 10.1016/j.avsg.2021.06.039
• Publication Date: 2021-10-09T04:34:04Z
• Authors: Karl Sörelius; Anders Wanhainen; Mia Furebring; Kevin Mani; T. Resch; R. Hultgren; C.M. Wahlgren; H. Roos; A. Öjersjö; D. Lindström; R. Vaccarino; B. Arvidsson; L. Bilos; A. Pirouzram; C. Arnerlöv; G. Simo; M. Svensson; J. Magnusson; H. Åstrand; M. Palm; M. Holsti; S. Mellander; D. Korman; K. Djavani-Gidlund; M. Huss; A. Bertszel; M. Docter; C. Drott; O. Nelzén; T. Wetterling; M. Chu; N-P. Gilgen; P. Gillgren
• Keywords: Male; Sweden; Staphylococcus aureus; microbiology; mycotic aortic aneurysm; Streptococcus; Kaplan-Meier Estimate; 3. Good health; 03 medical and health sciences; infection-related complications; 0302 clinical medicine; Salmonella; 616; Gram-Negative Bacteria; Humans; Female; bacteria; infective native aortic aneurysm; Aneurysm, Infected; Enterococcus; Aged

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.