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Journeau L, de la Chapelle M, Guimard T, Ferfar Y, Saadoun D, Mahé I, Castier Y, Montravers P, Lescure X, Van Gysel D, Asseray N, Lascarrou JB, Ngohou C, Vandamme YM, Connault J, de Cepoy PD, Brochard J, Goueffic Y, Pistorius MA, Boutoille D, Espitia O. A strobe multicenter descriptive study of 55 infectious aortitis. Medicine (Baltimore) 2020; 99:e22422. [PMID: 33019420 PMCID: PMC7535642 DOI: 10.1097/md.0000000000022422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Infectious aortitis (IA) is a rare and severe disease. The treatment classically associates open surgery with prolonged antibiotic therapy. This study aimed to describe clinical characteristics, medical and surgical supports in a large and current series of IA.We conducted a retrospective multicenter study of native aorta IA, between 2000 and 2019. Inclusion criteria were the presence of a microorganism on blood culture, aortic sample or any other validated technique and structural anomaly in imaging.We included 55 patients (85% men), with a median age of 65. Microbiology data substantially differed from previous studies with 12 Gram-negative rods IA, of which only 3 due to Salmonella spp., 24 Gram-positive cocci IA of which 12 Streptococcus spp., and 18 IA due to intracellular growth and/or fastidious microorganisms, of which 8 Coxiella burnetii, 3 Treponema pallidum, and 5 tuberculosis suspicious cases. Fifteen patients (27%) presented with thoracic IA, 31 (56%) with abdominal IA, and 9 (16%) with thoraco-abdominal IA. Eight patients had no surgery, 41 underwent open surgery, only 4 endovascular aneurysm repair, and 2 a combination of these 2 techniques. Nine patients died before 1-month follow-up. There was no difference in the mortality rate between the different types of germ or localization of IA.The variety of germs involved in IA increases. Positron emission tomography-computed tomography scan is a very useful tool for diagnosis. Surgery is still mainly done in open approach and a prospective multicenter study seems necessary to better determine the place of endovascular aneurysm repair versus open surgery.
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Affiliation(s)
- Louis Journeau
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
- Department of Internal Medicine, CHD René Dubos, Pontoise
| | | | | | - Yasmina Ferfar
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, INSERM, UMR_S 959, CNRS, FRE3632, Groupe Hospitalier Pitié-Salpêtrière (AP-HP)
| | - Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | - Xavier Lescure
- Department of Infectious Diseases, Hôpital Bichat – Claude Bernard (AP-HP), Paris
| | - Damien Van Gysel
- Department of Medical Information, Hôpital Louis Mourier (AP-HP), Colombes
| | | | | | | | | | | | | | - Julia Brochard
- Department of Infectious Diseases, Saint-Nazaire Hospital, Saint-Nazaire
| | - Yann Goueffic
- Department of Vascular Surgery, CHU Nantes, Nantes, France
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Katsuragawa F, Nagahama K, Naito S, Tsuura Y, Otani M, Koide T, Nishiyama S, Yanagi T, Nanamatsu A, Aki S, Aoyagi M, Tanaka H, Rai T, Uchida S. Ruptured infected aneurysm of the thoracic aorta associated with tunneled dialysis catheter-related methicillin-resistant Staphylococcus aureus bacteremia in a hemodialysis patient. CEN Case Rep 2018; 7:325-329. [PMID: 29987666 PMCID: PMC6181888 DOI: 10.1007/s13730-018-0352-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Abstract
Patients with an indwelling tunneled dialysis catheter (TDC) for hemodialysis access are at a high risk of developing methicillin-resistant Staphylococcus aureus (MRSA) infection. MRSA bacteremia complications rarely include infected aneurysm. Here, we report the first case of an infected thoracic aneurysm associated with TDC-related MRSA bacteremia. An 86-year-old Japanese male with a TDC for hemodialysis access developed TDC-related MRSA bacteremia. Intravenous vancomycin was initiated, and the TDC was removed on day 3. Despite removal of the catheter and initiation of vancomycin treatment, MRSA bacteremia persisted. Chest computed tomography (CT) showed no aneurysm; however, calcification of the thoracic aorta was detected on admission. The patient subsequently developed hemosputum. CT revealed a thoracic aneurysm, which turned out to be caused by MRSA bacteremia. The patient eventually died because of the rupture of the infected aneurysm, as confirmed by autopsy. This report demonstrates TDC management in a patient with TDC-related MRSA bacteremia and the importance of investigating a metastatic infection to a calcified artery if bacteremia persists.
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MESH Headings
- Administration, Intravenous
- Aged, 80 and over
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Anti-Bacterial Agents/therapeutic use
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/microbiology
- Aorta, Thoracic/pathology
- Asian People/ethnology
- Bacteremia/complications
- Catheters, Indwelling/adverse effects
- Catheters, Indwelling/microbiology
- Central Venous Catheters/adverse effects
- Central Venous Catheters/microbiology
- Fatal Outcome
- Humans
- Male
- Methicillin-Resistant Staphylococcus aureus
- Renal Dialysis/adverse effects
- Rupture
- Staphylococcal Infections/complications
- Staphylococcal Infections/microbiology
- Tomography, X-Ray Computed
- Vancomycin/administration & dosage
- Vancomycin/therapeutic use
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Affiliation(s)
- Fumiko Katsuragawa
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Graduate School of Medical Sciences, Kyorin University, Mitaka, Japan
| | - Shotaro Naito
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yukio Tsuura
- Department of Pathology, Yokosuka Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Megumi Otani
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Takaaki Koide
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Sakino Nishiyama
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Tomoki Yanagi
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Azuma Nanamatsu
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Shota Aki
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Makoto Aoyagi
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Hiroyuki Tanaka
- Department of Nephrology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa, 238-8558, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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