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Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts

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ABSTRACT

Coxiella burnetii vascular infections continue to be very severe diseases and no guidelines exist about their prevention. In terms of treatment, the benefit of the surgical removal of infected tissues has been suggested by 1 retrospective study.

We present a case of a C burnetii abdominal aortic graft infection for which we observed a dramatic clinical and biological recovery after surgery. We thus performed a retrospective cohort study to evaluate the impact of surgery on survival and serological outcome for patients with Q fever vascular infections diagnosed in our center.

Between 1986 and February 2015, 100 patients were diagnosed with Q fever vascular infections. The incidence of these infections has significantly increased over the past 5 years, in comparison with the mean annual incidence over the preceding 22 years (8.83 cases per year versus 3.14 cases per year, P = 0.001). A two-and-a-half-year follow-up was available for 66 patients, of whom 18.2% died. We observed 6.5% of deaths in the group of patients who were operated upon at 2 and a half years, in comparison with 28.6% in the group which were not operated upon (P = 0.02). Surgery was the only factor that had a positive impact on survival at 2 and a half years using univariate analysis [hazard ratio: 0.17 [95% CI]: [0.039–0.79]; P = 0.024]. Surgery was also associated with a good serological outcome (74.1% vs 57.1% of patients, P = 0.03). In the group of patients with vascular graft infections (n = 47), surgery had a positive impact on serological outcome at 2 and a half years (85.7% vs 42.9%, P < 0.001) [hazard ratio: 0.40 [95% CI]: [0.17–098]; P = 0.046] and tended to be associated with lower although not statistically significant mortality (11.1% vs 27.6% of deaths, P = 0.19).

Surgical treatment confers a benefit in terms of survival following C burnetii vascular infections. However, given the high mortality of these infections and their rising incidence, we propose a strategy that consists of screening for vascular graft and aneurysms in the context of primary Q fever, to decide when to start prophylactic treatment, similar to the strategy recommended for the prophylaxis of Q fever endocarditis.

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Comparison of the ratio of endocarditis to acute Q fever cases versus the ratio of vascular infection to acute Q fever cases diagnosed from 1986 to 2014.
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Figure 2: Comparison of the ratio of endocarditis to acute Q fever cases versus the ratio of vascular infection to acute Q fever cases diagnosed from 1986 to 2014.

Mentions: From January 1, 1986 to February 2015, 100 patients were diagnosed with C burnetii vascular infection in our laboratory. The mean annual incidence of vascular infection in the last 5 years has increased when compared with the mean annual incidence of the preceding 22 years (8.83 cases per year vs 3.14 cases per year, Pā€Š=ā€Š0.001) (Figure 2). In the same period, a total of 4691 cases of acute Q fever and 943 cases of endocarditis were diagnosed and we observed a 10-fold increase in the ratio of vascular infections to acute Q fever between 1986 and 2014 (Figure 2).


Treatment and Prophylactic Strategy for Coxiella burnetii Infection of Aneurysms and Vascular Grafts
Comparison of the ratio of endocarditis to acute Q fever cases versus the ratio of vascular infection to acute Q fever cases diagnosed from 1986 to 2014.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998359&req=5

Figure 2: Comparison of the ratio of endocarditis to acute Q fever cases versus the ratio of vascular infection to acute Q fever cases diagnosed from 1986 to 2014.
Mentions: From January 1, 1986 to February 2015, 100 patients were diagnosed with C burnetii vascular infection in our laboratory. The mean annual incidence of vascular infection in the last 5 years has increased when compared with the mean annual incidence of the preceding 22 years (8.83 cases per year vs 3.14 cases per year, Pā€Š=ā€Š0.001) (Figure 2). In the same period, a total of 4691 cases of acute Q fever and 943 cases of endocarditis were diagnosed and we observed a 10-fold increase in the ratio of vascular infections to acute Q fever between 1986 and 2014 (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Coxiella burnetii vascular infections continue to be very severe diseases and no guidelines exist about their prevention. In terms of treatment, the benefit of the surgical removal of infected tissues has been suggested by 1 retrospective study.

We present a case of a C burnetii abdominal aortic graft infection for which we observed a dramatic clinical and biological recovery after surgery. We thus performed a retrospective cohort study to evaluate the impact of surgery on survival and serological outcome for patients with Q fever vascular infections diagnosed in our center.

Between 1986 and February 2015, 100 patients were diagnosed with Q fever vascular infections. The incidence of these infections has significantly increased over the past 5 years, in comparison with the mean annual incidence over the preceding 22 years (8.83 cases per year versus 3.14 cases per year, P = 0.001). A two-and-a-half-year follow-up was available for 66 patients, of whom 18.2% died. We observed 6.5% of deaths in the group of patients who were operated upon at 2 and a half years, in comparison with 28.6% in the group which were not operated upon (P = 0.02). Surgery was the only factor that had a positive impact on survival at 2 and a half years using univariate analysis [hazard ratio: 0.17 [95% CI]: [0.039–0.79]; P = 0.024]. Surgery was also associated with a good serological outcome (74.1% vs 57.1% of patients, P = 0.03). In the group of patients with vascular graft infections (n = 47), surgery had a positive impact on serological outcome at 2 and a half years (85.7% vs 42.9%, P < 0.001) [hazard ratio: 0.40 [95% CI]: [0.17–098]; P = 0.046] and tended to be associated with lower although not statistically significant mortality (11.1% vs 27.6% of deaths, P = 0.19).

Surgical treatment confers a benefit in terms of survival following C burnetii vascular infections. However, given the high mortality of these infections and their rising incidence, we propose a strategy that consists of screening for vascular graft and aneurysms in the context of primary Q fever, to decide when to start prophylactic treatment, similar to the strategy recommended for the prophylaxis of Q fever endocarditis.

No MeSH data available.


Related in: MedlinePlus