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

Karl Sörelius; Anders Wanhainen; Mia Furebring; Kevin Mani; Swedish Collaborator Group for Infective Native Aortic Aneurysms

doi:10.1016/j.avsg.2021.06.039

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

Ann Vasc Surg. 2022 Jan:78:112-122. doi: 10.1016/j.avsg.2021.06.039. Epub 2021 Sep 17.

Authors

Karl Sörelius¹, Anders Wanhainen², Mia Furebring³, Kevin Mani²; Swedish Collaborator Group for Infective Native Aortic Aneurysms

Collaborators

Swedish Collaborator Group for Infective Native Aortic Aneurysms:
T Resch⁴, R Hultgren⁵, C M Wahlgren⁵, H Roos⁶, A Öjersjö⁷, D Lindström⁸, R Vaccarino⁹, B Arvidsson¹⁰, L Bilos¹¹, A Pirouzram¹¹, C Arnerlöv¹², G Simo¹³, M Svensson¹⁴, J Magnusson¹⁵, H Åstrand¹⁶, M Palm¹⁷, M Holsti¹², S Mellander¹⁸, D Korman¹⁹, K Djavani-Gidlund²⁰, M Huss⁵, A Bertszel²¹, M Docter²², C Drott²³, O Nelzén²⁴, T Wetterling²⁵, M Chu²⁶, N-P Gilgen²⁷, P Gillgren²⁸

Affiliations

¹ Department of Vascular Surgery, Rigshospitalet, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. Electronic address: karlsorelius@hotmail.com.
² Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
³ Department of Medical Sciences, Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
⁴ Department of Vascular Surgery, Rigshospitalet, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
⁵ Department of Vascular Surgery, Karolinska Hospital, Stockholm.
⁶ Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg.
⁷ Department of Surgery, Kalmar Hospital, Kalmar.
⁸ Department of Vascular Surgery, Uppsala University, Uppsala.
⁹ Vascular Centre, Skåne University Hospital, Malmö.
¹⁰ Department of Thoracic and Vascular Surgery, and Department of Medical and Health Sciences, Linköping University, Linköping.
¹¹ Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro.
¹² Department of Surgical and Perioperative Sciences, Surgery, Umeå University Hospital, Umeå.
¹³ Department of Surgery, Central Hospital Karlstad, Karlstad.
¹⁴ Department of Surgery, Falu Hospital, Falun.
¹⁵ Department of Surgery, Helsingborg Hospital, Helsingborg.
¹⁶ Department of Surgery, Jönköping Hospital, Jönköping.
¹⁷ Department of Surgery, Sunderby Hospital, Sunderbyn.
¹⁸ Department of Surgery, NU-Hospitalgroup, Trollhättan/Uddevalla.
¹⁹ Department of Surgery, Östersunds Hospital, Östersund.
²⁰ Department of Surgery, Gävle Hospital, Gävle.
²¹ Department of Vascular Surgery, Västerås Hospital, Västerås.
²² Department of Surgery, Hudiksvall Hospital, Hudiksvall.
²³ Department of Surgery, Borås Hospital, Borås.
²⁴ Department of Vascular Surgery, Skaraborg Hospital, Skoevde.
²⁵ Department of Surgery, Kristianstad Hospital, Kristianstad.
²⁶ Department of Surgery, Regional Hospital Sundsvall, Sundsvall.
²⁷ Department of Surgery, Mälar Hospital, Eskilstuna.
²⁸ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, and unit for Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm.

PMID: 34537347
DOI: 10.1016/j.avsg.2021.06.039

Abstract

Objective: 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).

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: bacteria; infection-related complications; infective native aortic aneurysm; microbiology; mycotic aortic aneurysm.

MeSH terms

Aged
Aneurysm, Infected / complications
Aneurysm, Infected / microbiology*
Aneurysm, Infected / mortality
Enterococcus / isolation & purification
Female
Gram-Negative Bacteria / isolation & purification
Humans
Kaplan-Meier Estimate
Male
Salmonella / isolation & purification*
Staphylococcus aureus / isolation & purification*
Streptococcus / isolation & purification*
Sweden