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Guided Aspiration for Determining the Microbiological Aetiology of Aortic Vascular Graft and Endograft Infections

Ljungquist, Oskar LU ; Dias, Nuno LU orcid ; Haidl, Sven LU ; Sonesson, Björn LU ; Sörelius, Karl and Ahl, Jonas LU (2021) In European Journal of Vascular and Endovascular Surgery 62(6). p.935-943
Abstract
Objective
Open and endovascular aortic repair may be complicated by aortic vascular graft or endograft infection (VGEI). Confirming the microbiological aetiology is a key element in providing the best available treatment to patients with a VGEI. The primary aim of this study was to describe the technique of direct aneurysm sac guided aspiration (DASGA) in determining the microbiological aetiology in a cohort of patients with VGEIs, and to report its diagnostic value.
Methods
This was a retrospective observational single centre study performed between the years 2011 to 2020 in Malmö, Sweden. Patients with a suspected aortic VGEI, where a DASGA was performed at the Vascular Centre, were included in the study.
Results
In... (More)
Objective
Open and endovascular aortic repair may be complicated by aortic vascular graft or endograft infection (VGEI). Confirming the microbiological aetiology is a key element in providing the best available treatment to patients with a VGEI. The primary aim of this study was to describe the technique of direct aneurysm sac guided aspiration (DASGA) in determining the microbiological aetiology in a cohort of patients with VGEIs, and to report its diagnostic value.
Methods
This was a retrospective observational single centre study performed between the years 2011 to 2020 in Malmö, Sweden. Patients with a suspected aortic VGEI, where a DASGA was performed at the Vascular Centre, were included in the study.
Results
In total, 31 guided aspirations were performed in 27 patients (25 male [93%]; median age 77 years [range 57 – 82 years]). The combination of culture and 16S rRNA/18S rRNA gave a microbial aetiology in 25/31 (81%) DASGAs. Importantly, excluding three cases where infection was ruled out, this rate increases up to 89%. A polymicrobial aetiology was found in six (24 %) cases. The most common bacteria found were Cutibacterium spp. (n = 8) and Listeria monocytogenes (n = 4). In total, the dominant aetiology could be further characterised into normal gut flora (n = 12; 48%) or skin commensals (n = 8; 32%). No patients had persistent morbidity related to the DASGA.
Conclusion
DASGA can be used successfully to determine the microbiological aetiology of open and endovascular graft infections. This method appears to be safe, with a high success rate for confirming the microbiological aetiology of VGEIs, particularly if standard culturing methods are combined with 16S rRNA/18S rRNA. Finding the causative microbial aetiology is crucial, and in the vast majority of cases translumbar puncture can be used without serious complications. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Vascular and Endovascular Surgery
volume
62
issue
6
pages
935 - 943
publisher
Elsevier
external identifiers
  • scopus:85116728134
  • pmid:34627681
ISSN
1532-2165
DOI
10.1016/j.ejvs.2021.08.006
language
English
LU publication?
yes
id
a0e4618b-29f2-414d-879f-925f1bc5e5b9
date added to LUP
2021-10-08 08:13:57
date last changed
2025-04-04 15:06:17
@article{a0e4618b-29f2-414d-879f-925f1bc5e5b9,
  abstract     = {{Objective<br/>Open and endovascular aortic repair may be complicated by aortic vascular graft or endograft infection (VGEI). Confirming the microbiological aetiology is a key element in providing the best available treatment to patients with a VGEI. The primary aim of this study was to describe the technique of direct aneurysm sac guided aspiration (DASGA) in determining the microbiological aetiology in a cohort of patients with VGEIs, and to report its diagnostic value.<br/>Methods<br/>This was a retrospective observational single centre study performed between the years 2011 to 2020 in Malmö, Sweden. Patients with a suspected aortic VGEI, where a DASGA was performed at the Vascular Centre, were included in the study.<br/>Results<br/>In total, 31 guided aspirations were performed in 27 patients (25 male [93%]; median age 77 years [range 57 – 82 years]). The combination of culture and 16S rRNA/18S rRNA gave a microbial aetiology in 25/31 (81%) DASGAs. Importantly, excluding three cases where infection was ruled out, this rate increases up to 89%. A polymicrobial aetiology was found in six (24 %) cases. The most common bacteria found were Cutibacterium spp. (n = 8) and Listeria monocytogenes (n = 4). In total, the dominant aetiology could be further characterised into normal gut flora (n = 12; 48%) or skin commensals (n = 8; 32%). No patients had persistent morbidity related to the DASGA.<br/>Conclusion<br/>DASGA can be used successfully to determine the microbiological aetiology of open and endovascular graft infections. This method appears to be safe, with a high success rate for confirming the microbiological aetiology of VGEIs, particularly if standard culturing methods are combined with 16S rRNA/18S rRNA. Finding the causative microbial aetiology is crucial, and in the vast majority of cases translumbar puncture can be used without serious complications.}},
  author       = {{Ljungquist, Oskar and Dias, Nuno and Haidl, Sven and Sonesson, Björn and Sörelius, Karl and Ahl, Jonas}},
  issn         = {{1532-2165}},
  language     = {{eng}},
  month        = {{10}},
  number       = {{6}},
  pages        = {{935--943}},
  publisher    = {{Elsevier}},
  series       = {{European Journal of Vascular and Endovascular Surgery}},
  title        = {{Guided Aspiration for Determining the Microbiological Aetiology of Aortic Vascular Graft and Endograft Infections}},
  url          = {{http://dx.doi.org/10.1016/j.ejvs.2021.08.006}},
  doi          = {{10.1016/j.ejvs.2021.08.006}},
  volume       = {{62}},
  year         = {{2021}},
}