Infrarenal Infected Aortic Aneurysm Caused by Streptococcus pyogenes

Table 1

A summary of infectious aortic aneurysms caused by Streptococcus pyogenes (table based on that of Gardiner et al.).

Case	References	Year	Age/sex	Site	Surgical treatment	Medical treatment; (empiric/directed)	Outcome
1	Valero et al. [38]	1992	65/M	Infrarenal abdominal aorta	Resection with right axillary femorofemoral bypass graft (day 1)	Ampicillin-sulbactam, aztreonam/nafcillin, penicillin G	Died 40 hours after admission because of developed disseminated intravascular coagulation
2	Sing et al. [39]	1994	58/F	Infrarenal abdominal aorta	Aortobifemoral graft	Not discussed antibiotics	Lumbar plexopathy and flaccid paralysis, walking with sticks at 18 months
3	Bisognano et al. [40]	1997	36/M	Aberrant origin right subclavian artery	Ligation of aberrant artery, aortic arch repair with Hemashield graft (day 2)	Not discussed “parenteral antibiotics”	Death day 8: brain death due to diffuse brain ischemia, obstructive hydrocephalus due to cerebellar infarct, transverse sinus thrombosis
4	Barth et al. [41]	2000	1.5/F	Ascending aorta	Aneurysmectomy, valveless aortic homograft (day 8)	Cefuroxime, gentamicin/high dose penicillin G (6 weeks), oral penicillin (3 months)	Well and active at 12 months
5	Chen et al. [42]	2008	81/M	Abdominal aorta	None	Not discussed	Died (aneurysm rupture)
6	Vallejo et al. [43]	2011	72/M	Thoracoabdominal aorta	Open resection, prosthetic graft implantation (rifampicin-impregnated)	Vancomycin, imipenem/penicillin G, benzathine penicillin 1 yr	Well at 6 months on penicillin
7	Leiva et al. [44]	2009	63/F	Thoracoabdominal aorta	Open resection, aortoiliac right, and aortofemoral left bypass with bifurcated prosthetic graft (rifampicin-impregnated) (3 weeks after diagnosis)	Vancomycin, Imipenem/Penicillin G (3 weeks) Penicillin G (1 year) after surgical treatment	Alive at 6 months
8	Hoffman et al. [45]	2012	2/M	Descending thoracic aorta	Open Dacron repair (day 3) and re-operation due to recurrence proximal to original graft	Ceftriaxone, ampicillin-sulbactam/Clindamycin, ampicillin (6 weeks)	Well at 6 weeks
9	Gardiner et al. [12]	2013	60/M	Infrarenal abdominal aorta	Initial endoluminal repair, complicated by secondary graft infection requiring graft excision, axillary-bifemoral bypass	Vancomycin, ceftriaxone, metronidazole/benzylpenicillin (5 weeks), piperacillin-tazobactam (6 weeks), amoxicillin-clavulanate (lifelong)	Well at 4 months, on amoxicillin-clavulanate
10	Present case	2012	69/F	Infrarenal abdominal aorta	Open resection and the infrarenal aorta were replaced with a homograft (4 weeks after diagnosis)	Piperacillin-tazobactam (2 days)/ceftriaxone (4 weeks and then 2 more weeks postoperatively); oral clindamycin (8 weeks) after surgical treatment	Alive at 84 months