Selective medical treatment of infected aneurysms of the aorta in high risk patients
Journal
Journal of Vascular Surgery
Journal Volume
49
Journal Issue
1
Pages
66-70
Date Issued
2009
Author(s)
Abstract
Background: Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. Methods: Retrospective chart review. Results: Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients. Conclusion: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients. ? 2009 The Society for Vascular Surgery.
SDGs
Other Subjects
amikacin; antibiotic agent; cefazolin; cefotaxime; ceftriaxone; ciprofloxacin; cotrimoxazole; ethambutol; flomoxef; isoniazid; oxacillin; rifampicin; teicoplanin; timentin; vancomycin; abdominal infection; adult; aged; aneurysm surgery; antibiotic sensitivity; antibiotic therapy; aorta aneurysm; article; cause of death; chest infection; clinical article; controlled study; Escherichia coli; Escherichia coli infection; event free survival; false aneurysm; female; follow up; hospital admission; human; infection; male; medical record review; mortality; Mycobacterium tuberculosis; priority journal; retrospective study; Salmonella; Salmonella choleraesuis; Salmonella typhimurium; salmonellosis; Staphylococcus aureus; Staphylococcus infection; surgical risk; treatment duration; tuberculosis; Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm; Disease-Free Survival; Female; Hospital Mortality; Humans; Male; Middle Aged; Patient Selection; Retrospective Studies; Risk Assessment; Time Factors; Treatment Outcome; Vascular Surgical Procedures
Type
journal article