rifampin and Aortic-Aneurysm--Abdominal

Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)-bonded J-Graft for C. fetus-induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus-associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Biopsy; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Campylobacter fetus; Campylobacter Infections; Coated Materials, Biocompatible; Humans; Male; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Endovascular aneurysm repair (EVAR) is now an established method of treating abdominal aortic aneurysms. Endovascular stent graft infection is a rare complication of EVAR. Diagnosis can be difficult and subsequent management challenging as a significant number of patients are unfit for further surgery and, untreated, graft infection is almost inevitably fatal. We present a case of an infected EVAR graft complicated by vertebral osteomyelitis that was treated conservatively. We discuss the diagnostic and therapeutic difficulties encountered and review the current literature on this evolving subject.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Clindamycin; Drug Administration Schedule; Drug Therapy, Combination; Endovascular Procedures; Gentamicins; Humans; Lumbar Vertebrae; Male; Osteomyelitis; Prosthesis-Related Infections; Rifampin; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

Infection of aortoiliac endografts is, to date, a rare complication of endovascular surgery. Staphylococcus species are the most common responsible pathogens, just as in cases with infected grafts after open aortic surgery. We report a case of a 65-year-old man with a history of diabetes mellitus and bladder cancer who developed stent-graft infection 3 years after endovascular treatment for a 5.6 cm abdominal aortic aneurysm. The diagnosis of endograft infection was established radiologically by computed tomographic scans. After intravenous administration of antibiotics and fluids to improve his clinical condition, the patient underwent surgical excision of the infected prosthesis and a bifurcated rifampicin-impregnated Dacron graft was placed in situ. Cultures from the purulent fluid around the aorta and from the endograft revealed development of Candida albicans. To our knowledge, this is the first case of an infected endograft due to a fungus. The patient died from septic shock 3 days postoperatively in the intensive care unit.

Topics: Aged; Anti-Bacterial Agents; Antifungal Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Candida albicans; Device Removal; Fatal Outcome; Humans; Male; Prosthesis-Related Infections; Rifampin; Stents; Tomography, X-Ray Computed

Infected aortic and iliac artery aneurysms are challenging to treat. Cryopreserved arterial allografts (CAAs) or rifampin-soaked Dacron (RSD) are standard options for in situ reconstruction. Our aim was to compare the safety and effectiveness of CAA versus RSD for these complex pathologies.. This is a retrospective review of infected iliac, abdominal, and thoracoabdominal aortic aneurysms treated with either CAAs or RSD between 2002 and 2022 at our institution. The diagnosis was confirmed by intraoperative, radiologic, or microbiological evidence of aortic infection. Perioperative events, 30-day and long-term mortality, reinfection, and reintervention were analyzed.. Thirty patients (17 CAA, 13 RSD) with a mean age of 61 and 68 years, respectively, were identified. The infected aneurysm was most commonly suprarenal or infrarenal. Culture-negative infections were present in 47% of the CAA group and 54% in the RSD group. Early major morbidity was 57% and 54% for the CAA and RSD, respectively. Thirty-day mortality was similar between groups (18% vs. 23% CAA vs. RSD, P ≥ 0.99). Median follow-up was longer in the RSD group (14.5 months vs. 13 months). Overall survival at 1 and 5 years was 80.8% and 64.8% in the CAA group and 69.2% and 57.7% in the RSD group. Reinterventions only occurred with CAA repairs and indications included graft occlusion (2), multiple pseudoaneurysms and reinfection (1), and hemorrhagic shock caused by graft rupture (1). Freedom from reintervention at 1 and 3 years was 87.5% and 79.5% (CAA group) versus 100% and 100% (RSD, P = 0.06). Freedom from reinfection at 1 year was 100% in both groups, while at 3 years it was 90.9% for the CAA group and 100% for the RSD group (P = 0.39).. Infected aortic and iliac aneurysms have high early morbidity and mortality. CAA and RSD had similar outcomes in our series; CAA trended toward higher reintervention rates. Both remain viable options for complex scenarios but require close surveillance.

Topics: Aged; Allografts; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Iliac Aneurysm; Middle Aged; Polyethylene Terephthalates; Reinfection; Retrospective Studies; Rifampin; Risk Factors; Treatment Outcome

A 65-year-old man presented with an infected perivisceral aortic aneurysm after previous treatment of an abdominal aortic aneurysm with an endograft. On presentation, he was septic and had occlusion of the celiac, superior mesenteric, inferior mesenteric, and bilateral renal arteries. He underwent a three-stage procedure: first, axillobifemoral bypass; then resection of the thoracoabdominal aorta; and finally bypass from the ascending aorta to the celiac and superior mesenteric arteries with a rifampin-soaked Gelsoft graft (Vascutek, Renfrewshire, Scotland). The abdominal pain resolved, and the patient remains symptom free 10 months postoperatively. This rare surgical revascularization technique offered a nontraditional solution to a difficult surgical issue.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Celiac Artery; Coated Materials, Biocompatible; Collateral Circulation; Computed Tomography Angiography; Device Removal; Endovascular Procedures; Hepatic Artery; Humans; Male; Mesenteric Artery, Superior; Mesenteric Ischemia; Mesenteric Vascular Occlusion; Prosthesis-Related Infections; Reoperation; Rifampin; Splanchnic Circulation; Treatment Outcome

Infections involving the aorta are associated with high rates of morbidity and mortality, and their management is complex. Saturating Dacron grafts in rifampin (60 mg/mL) inhibits the growth of organisms commonly found to be involved in both primary aortic infections and aortoenteric fistulas. Open repair and replacement of the aorta with rifampin-soaked Dacron grafts is frequently used in clinical practice and is considered a viable option for open repair with a low recurrence of infection; however, the morbidity and mortality of the procedure is significant. More recently, patients who are high risk for open surgery have been managed with endografts to treat infected aortas and aortoenteric fistulas with limited success, a high recurrence rate, and elevated mortality. We describe a technique to expose Dacron endografts with rifampin delivered via injection port or into the sheath before deployment in selected patients with aortic infections. We used this novel technique in 2 patients who were high risk for open repair: 1 with a bleeding aortoenteric fistula and 1 with mycotic abdominal aortic aneurysm. The first patient tolerated 1.5 years without surgical correction of the duodenal defect after placement of a rifampin-treated endograft. This allowed her to recover and ultimately undergo definitive repair under elective circumstances. Our second patient remains without evidence of recurrence 1 year after implantation for a mycotic abdominal aortic aneurysm. Following the principles of rifampin use in open vascular repairs, treating Dacron endografts with rifampin may add similar antimicrobial resistance when used to treat selected aortic infections.

Topics: Adult; Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience.. Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting.. One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%.. In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.

Topics: Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Bacteremia; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Elective Surgical Procedures; Enterobacteriaceae Infections; Female; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Omentum; Polyethylene Terephthalates; Retrospective Studies; Rifampin; Stents; Surgical Flaps; Treatment Outcome

Topics: Alcoholism; Amoxicillin; Aneurysm, Infected; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aortic Aneurysm, Abdominal; Aortitis; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Discitis; Disease Susceptibility; Humans; Lumbar Vertebrae; Male; Middle Aged; Naproxen; Pneumococcal Infections; Psoas Abscess; Pulmonary Disease, Chronic Obstructive; Rifampin; Tomography, X-Ray Computed

Stent-graft infections after endovascular aneurysm repair are rare but can have devastating consequences. Open surgery to treat such infections is associated with considerable morbidity and mortality. Removal of the stent-graft is technically challenging, especially when it has a suprarenal fixation. Several in situ reconstructions have been described, with varying results. We report a case in which a Zenith stent-graft became infected after endovascular aneurysm repair to treat an abdominal aortic aneurysm and blue toe syndrome. The endoprosthesis was removed completely, and in situ reconstruction was performed successfully and without complications by using a rifampin-soaked Dacron graft.

Topics: Aged, 80 and over; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Blue Toe Syndrome; Coated Materials, Biocompatible; Device Removal; Endovascular Procedures; Humans; Male; Prosthesis Design; Prosthesis-Related Infections; Reoperation; Rifampin; Stents; Tomography, X-Ray Computed; Treatment Outcome

Bacillus Calmette-Guérin (BCG) is a live attenuated strain of Mycobacterium bovis that has been widely used for the treatment of superficial transitional cell carcinoma of the bladder. We describe a rare case of supra-renal mycotic aortic aneurysm secondary to BCG instillation in a 75-year-old male. Patients presenting with systemic symptoms post-instillation, possibly with an aneurysm, should raise suspicion of BCG dissemination, which requires early instigation of anti-mycobacterial drugs.

Topics: Administration, Intravesical; Aged; Aneurysm, Infected; Antibiotics, Antitubercular; Aorta, Abdominal; Aortic Aneurysm, Abdominal; BCG Vaccine; Carcinoma, Transitional Cell; England; Ethambutol; Fatal Outcome; Humans; Isoniazid; Male; Mycobacterium bovis; Mycobacterium Infections; Rifampin; Tomography, X-Ray Computed; Urinary Bladder Neoplasms

A 76-year-old female presented with constipation and anorexia Computed tomography (CT) revealed a saccular aneurysm (35 mm in diameter) directly over the root of the celiac artery, and she was referred to our department and was admitted. Klebsiella pneumoniae was detected in blood culture. Although antibiotics were administered, the inflammatory response was not improved. On day 8 after hospitalization, CT revealed the aneurysm increased. Therefore, surgery was performed. Aneurysm was observed adjacent to the celiac artery. The excised aorta included the descending thoracic aorta and the superior mesenteric artery, and was replaced with a rifampicin-soaked Vasctec Gelweave 24 mm vascular graft with branches. After hemostasis, omental implantation was performed around the vascular graft. Before surgery, sufficient antibiotics administration is desirable to bring the infection under control. However, if infection is uncontrollable with progressive enlargement of the aneurysm, as in this case, surgery is unavoidable. A combination of treatments was successful.

Topics: Aged; Aneurysm, Infected; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Omentum; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures

A 64-year-old man was admitted with abdominal pain 6 weeks after treatment with intravenous flucloxacillin for cellulitis of his right leg. Urgent operation was necessary for a mycotic aneurysm of the abdominal aorta due to infection with Pasteurella multocida, a microorganism residing in the oral cavity of domestic animals that very rarely causes infection of native arteries or grafts. The aorta was repaired with a rifampin-coated tube graft. Despite postoperative duodenal perforation, abdominal Candida infections, wound dehiscence, and renal insufficiency, the patient is alive 1 year postoperatively.

Topics: Abdominal Pain; Alcoholism; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Humans; Male; Middle Aged; Pasteurella multocida; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

Acute infection of an aortic graft is a devastating complication. While resection of the infected prosthesis and extra-anatomic bypass is the established treatment, this carries a high mortality. We describe a case of early aortic graft infection with the unusual organism Acinetobacter baumanii, which was eradicated by a combination of surgical drainage and antibiotics, allowing preservation of the graft. The patient remains well 30 months later.

Topics: Acinetobacter baumannii; Aged; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Debridement; Female; Gentamicins; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Prosthesis-Related Infections; Rifampin; Treatment Outcome

To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis.. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured mycotic TAAA extending to the celiac axis. The aneurysm was excluded with a stent-graft soaked in rifampicin and deployed to deliberately occlude the celiac axis for effective distal sealing and fixation. The patient recovered well and was prescribed antibiotic treatment for up to 6 months.. Endovascular repair of a ruptured TAAA may be a life-saving option. In emergency situations when poor distal anatomy is present, covering the celiac artery with the stent-graft should be considered.

Topics: Abdominal Pain; Aged; Aneurysm, Infected; Angiography; Angioplasty, Balloon; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Celiac Artery; Diarrhea; Emergencies; Fatigue; Female; Fever; Humans; Patient Selection; Prosthesis Design; Rifampin; Stents; Tomography, X-Ray Computed; Treatment Outcome

Coxiella burnetii, the etiologic agent of Q fever, is mainly responsible for endocarditis with negative blood culture results, but only a few cases of C. burnetii infections of aortic aneurysms have been published. We report three cases of abdominal aortic aneurysms treated in patients with Q fever infection with simultaneous endocarditis (n = 1) and previous history of cardiac valve replacement for endocarditis (n = 1). A coeliac aortic aneurysm was diagnosed in one patient treated for acute Q fever with persistent serologic results showing chronic infection despite adequate antibiotic therapy and without endocarditis. Resection of the aneurysm cured the chronic infection, and C. burnetii was identified by culture of the aneurysmal wall. In the two other cases, chronic infection of C. burnetii was diagnosed by serologic examination after surgery for an abdominal aortic aneurysm. One patient with negative blood culture results had amaurosis fugax due to endocarditis and required aortic valve replacement; recurrent fever without evidence of valve dysfunction or infection developed in one patient who had had prosthetic cardiac valve replacement 6 months earlier for endocarditis. Aortic aneurysms were treated with in situ prosthetic grafts and long-term antibiotic therapy. At a mean follow-up of 12 years, no septic aortic complications occurred, and serologic test results have remained negative. The presence of an aortic aneurysm and cardiac valve disease seems to be a predisposing factor for chronic C. burnetii infection. Diagnosis particularly relies on the physician's awareness of this condition and is confirmed by serologic examination. Aortic aneurysm resection is mandatory to cure the chronic infection and must be associated with long-term antibiotic therapy.

Topics: Aged; Aneurysm, Infected; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis Implantation; Chronic Disease; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Female; Heart Valve Prosthesis Implantation; Humans; Iliac Artery; Male; Middle Aged; Q Fever; Rifampin

Secondary aortoenteric fistulas remain challenging diagnostic and therapeutic problems. Although the duodenum is most frequently involved, other intestinal segments are possible sites for fistulization. We report here a case of graft-appendiceal fistula revealed by recurrent gastrointestinal bleeding 11 years after abdominal aortic aneurysm replacement. The preoperative diagnosis was not achieved by endoscopy or imaging assessment. Despite recommended principles of total graft excision and extraanatomic bypass, appendectomy and in situ rifampin-bonded graft reconstruction were performed because of the advanced age and poor arterial runoff. The postoperative course was uneventful and the patient remains well 17 months after operation.

Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Aortic Diseases; Appendix; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Cecal Diseases; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Polyethylene Terephthalates; Postoperative Complications; Rifampin; Time Factors; Vascular Fistula

Prosthetic graft infection after aortic aneurysm surgery is a life-threatening complication. Treatment options include total graft excision and extra-anatomic bypass grafting or in situ replacement of the graft. The latter option is gaining increasing popularity, but the long-term outcome remains uncertain, particularly in light of the increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA). We performed a prospective nonrandomized study to assess the outcome after graft excision and in situ replacement with a rifampicin-bonded prosthesis for the treatment of major aortic graft infection.. In a 6-year period from January 1992 to December 1997, 11 patients (eight men, three women) with major aortic graft infection underwent total graft excision and in situ replacement with a rifampicin-bonded prosthesis. The median age of the patients was 66 years (range, 49 to 78 years). Four patients had a hemorrhage from an aortoenteric fistula, three had a retroperitoneal abscess, two had graft occlusion, one had a perigraft collection shown by means of computed tomography, and one had a ruptured suprarenal false aneurysm. Organisms were cultured from 10 patients.. MRSA was isolated in two patients, both of whom had originally undergone repair of a ruptured abdominal aortic aneurysm. Two patients died (18.2%) within 30 days, and three patients (27.6%) had nonfatal complications (peritoneal candidiasis, transient renal impairment, and profound anorexia). Two patients died late in the follow-up period. Seven patients remain alive and clinically free of infection.. The long-term results after total graft excision and in situ replacement with a rifampicin-bonded prosthesis appear to be favorable. However, MRSA aortic graft infection appears to be associated with a poor prognosis.

Topics: Aged; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Female; Humans; Male; Methicillin Resistance; Prospective Studies; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections

Treatment of mycotic aortic aneurysm by excision and extraanatomic bypass is difficult to apply when the infectious process involves the visceral arteries. On the basis of experimental studies in our laboratory that demonstrated prolonged antistaphylococcal activity of rifampin-bonded, gelatin-impregnated Dacron grafts after implantation in the arterial circulation, this conduit was successfully used for in situ replacement of a native aortic infection in two patients. Both patients had fever, leukocytosis, abdominal or back pain, and a computed tomographic scan that demonstrated contained rupture of a mycotic aneurysm. Preoperative computed tomography-guided aspiration and culture of periaortic fluid from one patient grew Staphylococcus aureus. Treatment consisted of prolonged (6 weeks) culture-specific parenteral antibiotic therapy, excision of involved aorta, oxychlorosene irrigation of the aortic bed, and restoration of aortic continuity by in situ prosthetic replacement. A preliminary right axillobifemoral bypass was performed in the patient who had an infection involving the suprarenal and infrarenal aorta. In both patients intraoperative culture of aorta wall recovered S. aureus. Patients were discharged at 20 and 21 days. Clinical follow-up and computed tomographic imaging of the replacement graft beyond 10 months after surgery demonstrated no signs of residual aortic infection. In the absence of gross pus and frank sepsis, the use of an antibiotic-bonded prosthetic graft with antistaphylococcal activity should be considered in patients who have arterial infections caused by S. aureus when excision and ex situ bypass are not feasible.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Female; Gelatin; Humans; Male; Polyethylene Terephthalates; Rifampin; Staphylococcal Infections; Tomography, X-Ray Computed; Vascular Surgical Procedures

Topics: Aged; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Diseases; Blood Vessel Prosthesis; Female; Humans; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections; Rifampin