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Mycotic aneurysm in northeastern Thailand: the important role of Burkholderia pseudomallei

Abstract number: P1632

Anunnatsiri S., Chetchotisakd P.

Objectives: Mycotic aneurysm is a rare condition and related to devastating outcomes. Based on the limited data of the disease, the study was conducted to evaluate the natural history and clinical outcomes of mycotic aneurysm in northeastern Thailand, where melioidosis is an endemic.

Methods: A 15-year retrospective study was conducted in Srinagarind University Hospital during January 1993–June 2007. All patients with mycotic aneurysm based on clinical presentations, radiographic features, intra-operative surgical findings, and pathological reports during the study period were eligible to the study.

Results: There were 37 cases with diagnosis of mycotic aneurysm. The majority of patients were male (29 cases, 78.7%) and elder as the mean (SD) age of 62.9 (12.1) years. Of those, 21 cases (56.8%) had pre-existing diseases, which the 3 most common diseases were diabetes mellitus, chronic kidney diseases and hypertension. All patients presented with pain at the aneurysm site and fever was found in 25 cases (67.6%). Median (range) duration of illness was 14 (3–150) days. Thirty-three cases (89.2%) were involved abdominal aorta. All but one were culture-proven mycotic aneurysm cases. The most common aetiological pathogens were Burkholderia pseudomallei (15 cases, 40.5%), followed by Salmonella group D (10 cases, 27.0%). Escherichia coli and Pseudomonas sp. were found two cases each. Salmonella group B, Staphylococcus aureus, Aeromonas hydrophila, Klebsiella pneumoniae, Enterobacter sp., Enterococcus sp., and non-hemolytic Streptococcus not group D was found one case each. The most common sites of pathogen isolation were aneurysm (29 cases, 78.4%), followed by blood (7 cases, 18.9%). Overall in-hospital mortality rate was 24.3% (9 cases; 4 cases in B. pseudomallei mycotic aneurysm).

There were no statistically significant differences according to age, sex, pre-existing diseases, clinical presentations, site of aneurysm, and mortality between patients with mycotic aneurysm causing by B. pseudomallei and other bacteria. Postoperative complications was significantly more common in patients with B. pseudomallei mycotic aneurysm compared to those with other bacteria [10 cases (66.7%) vs. 4 cases (19.0%); p = 0.01].

Conclusion: In endemic area of melioidosis, the empirical antimicrobial therapy for suspected mycotic aneurysm should cover B. pseudomallei.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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