Long-term follow-up of positive cultures in 500 abdominal aortic aneurysms
J. C. Farkas, J. M. Fichelle, C. Laurian, A. Jean-Baptiste, F. Gigou, J. Marzelle, F. W. Goldstein and J. M. Cormier
Department of Vascular Surgery, Hopital Saint Joseph, Paris, France.
Routine aneurysm culture is frequently performed as it is thought that a
positive culture could be a risk factor for secondary graft infection. Five
hundred aneurysms, in a series of 796 patients, had microbiologic
examination of the thrombus and/or aneurysm wall. Cultures were positive in
185 cases (37%), mostly due to normal skin flora microorganisms (80%),
whereas 16 patients (3.2%) had infectious aortitis. Gram-stained smears
were positive in nine of these 16 patients compared with two of the other
169. Of the 185 patients with positive culture, after a mean length of
follow-up of 35 months, only one had a graft infection that occurred 6
years later and was not due to the same microorganism. Graft sepsis was
diagnosed in six of the 296 patients who did not have a positive culture,
and was related to clinically obvious locoregional or systemic foci. In
this series, positive cultures from aneurysm without rupture or signs of
infection were not a risk factor for secondary graft sepsis. Therefore, in
cases of asymptomatic unruptured aneurysm, routine culturing is not
necessary as a positive result has no pathogenic significance or
therapeutic implication.