Aortic infections

  • 文章类型: Journal Article
    主动脉感染仍然是具有高发病率和高死亡率的临床挑战。发病率在0.6和2.6%之间变化。移植物感染稳步增加,尤其是移植物感染,由于增加了程序(0.2%至5%)。葡萄球菌仍然是最常见的生物;然而,还报告了革兰氏阴性和罕见的病原体。临床表现可能非常多样,需要高度怀疑才能诊断它们。有时候,他们可能出现破裂或瘘管的紧急情况。诊断是基于临床特征的三联征,微生物培养和成像。在整个过程中,培养特异性抗生素是强制性的,但很少单独治愈。手术管理仍然是护理标准,涉及清创的综合方法,附件的重建和使用。已经描述了具有优点和局限性的各种主动脉替代物。心包管移植物已成为一种不错的选择。内血管选择主要是作为最终手术的桥梁。描述了保守管理的小角色。对肠道和气道的主动脉瓣瘘具有非常高的死亡率。文献中没有大型系列来定义指南指导治疗,并且通常是定制解决方案。30天死亡率仍然接近30%。结果取决于多种因素,包括患者的年龄,介绍的时间,诊断,致病生物,宿主状态和采用的治疗策略。
    Infection of the aorta continues to be a clinical challenge with high morbidity and mortality. The incidence varies between 0.6 and 2.6%. There has been a steady increase in graft infections, especially endograft infections, due to increased procedures (0.2 to 5%). Staphylococcus species remains the most common organism; however, gram-negative and rare causative agents are also reported. The clinical presentation can be very diverse and a high degree of suspicion is necessary to diagnose them. Sometimes, they may present as an emergency with rupture or fistulation. Diagnosis is based on a triad of clinical features, microbial cultures and imaging. Culture-specific antibiotics are mandatory during the entire course, but seldom cure alone. Surgical management remains the standard of care and involves an integrated approach involving debridement, reconstruction and use of adjuncts. Various aortic substitutes have been described with advantages and limitations. Pericardial tube grafts have emerged as a good option. Endo-vascular options are practiced mostly as a bridge to definitive surgery. A small role for conservative management is described. Aortic fistulation to the gut and airway carries a very high mortality. There are no large series in the literature to define guideline-directed treatment and most often it is a customized solution. The 30-day mortality remains close to 30%. Outcomes depend on multiple factors including patient\'s age, the timing of presentation, diagnosis, causative organism, host status and the treatment strategy adopted.
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