Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Case Series
3.2. Literature Review
4. Discussion
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
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N | Age (y), Sex (M/F) | Comorbidities | Aortic Prosthesis Implant | Clinical Picture | ||
---|---|---|---|---|---|---|
Reason for Primary Vascular Implant (Type of Procedure) | Time from Implant to Presentation | Presentation | Aorto-Enteric Fistula | |||
1 | 73, M | Appendectomy, previous AKI on CVVH | AAA rupture with intestinal ischemia (EVAR and sigmoidectomy) | 7 m | Abdominal pain and hemoptysis | Yes (ileum) |
2 | 81, M | Hypertension, atrial fibrillation, previous SARS-CoV-2 pneumonia | infectious AAA due to Salmonella spp. (EVAR) | 6 m | Fever and lumbar pain | Not identified |
3 | 77, M | Dialysis | AAA (aorto-biiliac prosthesis, procedure unknown) | 4 y | Fever, lumbar pain and intestinal bleeding | Yes (duodenum) |
4 | 69, M | Cardias adenocarcinoma treated surgically + chemotherapy + radiotherapy, complicated with esophageal fistula surgically repaired (10 y before), previous lymphoma | infectious AAA rupture secondary to gastrointestinal infection (EVAR and PTA of left common iliac artery) | 4 m | Low-grade fever and septic shock | Not identified |
5 | 76, F | Mammary carcinoma treated surgically (4 y), left TKA, intestinal subocclusion (2 y), COPD, hypertensive cardiomyopathy, amoxicillin allergy (rash) | infectious AAA rupture due to Salmonella spp. (EVAR) with subsequent abscessualization of aneurysmatic sac and vertebral osteomyelitis requiring surgical drainage and spine stabilization | 10 m | S. aureus vertebral implant infection with wound dehiscence later complicated with polymicrobial BSIs | Not identified |
N | Microbiological Results | Treatment | Outcome | |
---|---|---|---|---|
Antibiotic Therapy | Surgery | |||
1 | A. odontolyticus (I) C. albicans (I) | iv: meropenem + micafungin (2 w) then os: amoxicillin (long-term) + fluconazole (11 m) | Explant and substitution | Periprosthetic abscess of the psoas muscle (2 y f-up) |
2 | A. odontolyticus (I) Salmonella spp. (I) | iv: ceftriaxone + ampicillin (12 w) then os: amoxicillin (10 m) | Explant and substitution | Recovered (2 y f-up) |
3 | A. odontolyticus (B) | os: amoxicillin (long-term) | Not performed | Death (37 d) |
4 | A. odontolyticus (B) S. anginosus (B) Salmonella spp. (S) | iv: daptomycin + amoxi/clav. (3 w) then os: amoxiclav. (15 d) | Explant and bypass | Recovered (3 y f-up) |
5 | Actinomyces spp. (B) S. aureus (B) E. coli (B) | iv: meropenem (2 w) then os: cotrimoxazole + rifampin (long-term) | Not performed | Death (7 m) |
Case Report | Age (y), Sex (M/F) | Comorbidities | Aortic Prosthesis Implant | Clinical Picture | ||
---|---|---|---|---|---|---|
Reason for Primary Vascular Implant (Type of Procedure) | Time from Implant to Presentation | Presentation | Aorto-Enteric Fistula (AEF) | |||
Delarbre (2007) [10] | 73, M | Peripheral obliterant arteriopathy, arterial hypertension, dyslipidemia, COPD, CKD, periodontal disease | Peripheral obliterant arteriopathy (aortobiiliac prosthesis, OSR) | 7 y | Fever and lumbar pain | Yes (duodenum) |
Bush (2009) [11] | 79, M | - | - (EVAR) | 8 y | Fever and abdominal pain irradiating to the back | Yes (duodenum) |
Lane (2009) [12] | 69, M | - | Infrarenal AAA (EVAR) | 6 m | Fever, lethargy, diarrhea | Yes (duodenum) |
Hansen (2017) [13] | 75, M | - | Ruptured infrarenal AAA (EVAR) complicated with graft infection (isolation of S. milleri, E. corrodens, Bacteroides sp.) at 2 y, treated with graft revision (without explant), AEF closure, antibiotic therapy (meropenem iv followed by ciprofloxacin and clindamycin for 3 m) | 4 y | Fever | Yes (duodenum) |
Blank (2017) [14] | 54, M | Hypertension, hyperlipidemia, asthma, diverticulitis | Acute limb ischemia (open aortobifemoral bypass) | 6 m | Fever, left leg pain | Yes * (sigmoid colon) |
Puges (2018) [16] | - | - | - | >4 m | - | Yes (-) |
Howgego (2021) [15] | 68, M | - | Ruptured AAA with primary AEF (EVAR) complicated with graft infection at 3 m, treated with graft revision (without explant) and long-term amoxiclavulanate | 1 y | Sepsis | No |
Puges (2021) [17] | 78, M | - | - | 6 y | Fever, back pain and acute respiratory failure | No ^ |
Case Report | Microbiological Results | Treatment | Outcome | |
---|---|---|---|---|
Antibiotic Therapy | Surgery | |||
Delarbre (2007) [10] | A. odontolyticus (B) E. coli (B, I) E. faecium (I) Candida albicans (I) | First (conservative) iv: amoxicillin iv (3 w) + gentamicin (10 d); then os: amoxicillin (8 m) | First: Not performed | First: failure; |
Second: iv: imipenem + amikacin + fluconazole (2 w) | Second: Explant and graft replacement | Second: Recovered (6 y f-up) | ||
Bush (2009) [11] | Actinomyces spp. (B) S. constellatus (B, I) P. melaninogenica (B) S. lugdunensis (I) | iv: ampic./sulbactam (8 w) | Explant and axillo-bifemoral graft bypass | Recovered (2 m f-up) |
Lane (2009) [12] | A. israelii (I) B. fragilis (I) | Unknown (“suppressive antibiotics”) | Explant and axillo-bifemoral graft bypass | Discharged (-) |
Hansen (2017) [13] | Actinomyces spp. (B) | Unknown (“suppressive antibiotics”) | Not performed | Recurrent sepsis and digestive bleeding (alive at 12 y f.up) |
Blank (2017) [14] | A. odontolyticus (I) S. epidermidis (I) S. anginosus (I) | iv: tigecycline (6 w) then os: doxycicline (6 w) | Explant and axillary-femoral bypass, colectomy | Recovered (1 y f-up) |
Puges (2018) [16] | A. odontolyticus (I) K. pneumoniae (I) V. parvula (I) C. albicans (I) C. tropicalis (I) | - | - | - |
Howgego (2021) [15] | Actinomyces spp. (B) E. faecium (B) | iv: meropenem (later ertapenem) + vancomycin (later teicoplanin) then: long-term amoxiclavulanate | Not performed | Discharged, permanent kidney dysfunction (-) |
Puges (2021) [17] | A. odontolyticus (I) S. anginosus (I) S. oralis (I, B) Coxiella burnetii (serology and PCR) | Unknown (no Coxiella treatment) | - | Died at 37 d |
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Del Fabro, G.; Volpi, S.; Fumarola, B.; Migliorati, M.; Bertelli, D.; Signorini, L.; Matteelli, A.; Meschiari, M. Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature. Microorganisms 2023, 11, 2931. https://doi.org/10.3390/microorganisms11122931
Del Fabro G, Volpi S, Fumarola B, Migliorati M, Bertelli D, Signorini L, Matteelli A, Meschiari M. Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature. Microorganisms. 2023; 11(12):2931. https://doi.org/10.3390/microorganisms11122931
Chicago/Turabian StyleDel Fabro, Giovanni, Sara Volpi, Benedetta Fumarola, Manuela Migliorati, Davide Bertelli, Liana Signorini, Alberto Matteelli, and Marianna Meschiari. 2023. "Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature" Microorganisms 11, no. 12: 2931. https://doi.org/10.3390/microorganisms11122931
APA StyleDel Fabro, G., Volpi, S., Fumarola, B., Migliorati, M., Bertelli, D., Signorini, L., Matteelli, A., & Meschiari, M. (2023). Actinomyces spp. Prosthetic Vascular Graft Infection (PVGI): A Multicenter Case-Series and Narrative Review of the Literature. Microorganisms, 11(12), 2931. https://doi.org/10.3390/microorganisms11122931