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Epidemiology and Risk Factors of Mycotic Aneurysm in Patients With Infective Endocarditis and the Impact of its Rupture in Outcomes. Analysis of a National Prospective Cohort.
Calderón-Parra, Jorge; Domínguez, Fernando; González-Rico, Claudia; Arnaiz de Las Revillas, Francisco; Goenaga, Miguel Ángel; Alvarez, I; Muñoz, Patricia; Alonso, David; Rodríguez-García, Raquel; Miró, José María; De Alarcón, Arístides; Antorrena, Isabel; Goikoetxea-Agirre, Josune; Moral-Escudero, Encarnación; Ojeda-Burgos, Guillermo; Ramos-Martínez, Antonio.
Afiliación
  • Calderón-Parra J; Infectious Diseases Unit, Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Spain.
  • Domínguez F; Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain.
  • González-Rico C; Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain.
  • Arnaiz de Las Revillas F; Department of Cardiology, Puerta de Hierro University Hospital, Majadahonda, Spain.
  • Goenaga MÁ; Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University, Santander, Spain.
  • Alvarez I; Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University, Santander, Spain.
  • Muñoz P; Department of Infectious Diseases, OSI Donostialdea, San Sebastian, Spain.
  • Alonso D; Department of Infectious Diseases, OSI Donostialdea, San Sebastian, Spain.
  • Rodríguez-García R; Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University, Madrid, Spain.
  • Miró JM; Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University, Madrid, Spain.
  • De Alarcón A; Intensive Care Department, University Hospital of Asturias, Oviedo, Spain.
  • Antorrena I; Department of Infectious Diseases, Clinic Hospital-IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Goikoetxea-Agirre J; Infectious Diseases, Microbiology, and Parasitology Unit, University Hospital Virgen del Rocio, Seville University, Seville, Spain.
  • Moral-Escudero E; Cardiology Department, University Hospital La Paz- IDIPAZ, Madrid, Spain.
  • Ojeda-Burgos G; Infectious Diseases Department, University Hospital Cruces, Bilbao, Spain.
  • Ramos-Martínez A; Internal Medicine Department, University Hospital Virgen de la Arrixaca, Murcia, Spain.
Open Forum Infect Dis ; 11(3): ofae121, 2024 Mar.
Article en En | MEDLINE | ID: mdl-38500574
ABSTRACT

Background:

Several aspects of the occurrence and management of mycotic aneurysm (MA) in patients with infective endocarditis (IE) have not been studied.

Objectives:

To determine the incidence and factors associated with MA presence and rupture and to assess the evolution of those initially unruptured MA.

Methods:

Prospective multicenter cohort including all patients with definite IE between January 2008 and December 2020.

Results:

Of 4548 IE cases, 85 (1.9%) developed MA. Forty-six (54.1%) had intracranial MA and 39 (45.9%) extracranial MA. Rupture of MA occurred in 39 patients (45.9%). Patients with ruptured MA had higher 1-year mortality (hazard ratio, 2.33; 95% confidence interval, 1.49-3.67). Of the 55 patients with initially unruptured MA, 9 (16.4%) presented rupture after a median of 3 days (interquartile range, 1-7) after diagnosis, being more frequent in intracranial MA (32% vs 3.3%, P = .004). Of patients with initially unruptured MA, there was a trend toward better outcomes among those who received early specific intervention, including lower follow-up rupture (7.1% vs 25.0%, P = .170), higher rate of aneurysm resolution in control imaging (66.7% vs 31.3%, P = .087), lower MA-related mortality (7.1% vs 16.7%, P = .232), and lower MA-related sequalae (0% vs 27.8%, P = .045).

Conclusions:

MA occurred in 2% of the patients with IE. Half of the Mas occurred in an intracranial location. Their rupture is frequent and associated with poor prognosis. A significant proportion of initially unruptured aneurysms result from rupture during the first several days, being more common in intracranial aneurysms. Early specific treatment could potentially lead to better outcomes.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Open Forum Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Open Forum Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos