Early pyrexia after endovascular aneurysm repair: are cultures needed?

Abstract

INTRODUCTION The post-implantation syndrome after endovascular aneurysm repair (EVAR) is increasingly recognised. However, when non-vascular trainees are responsible for the care of these patients out of hours, many are investigated if pyrexial. This study assesses the role of microbiological investigations in pyrexia after endovascular aneurysm repair. PATIENTS AND METHODS The notes of 75 EVAR patients were reviewed retrospectively. The incidence of postoperative pyrexia and infective complications were calculated and the result of any cultures obtained. RESULTS Overall, 58 (77.3%) patients were pyrexial with 48 h of stent insertion. Twenty-four had blood cultures and 12 had urine cultures taken within 48 h of surgery. All of these cultures were negative. However, of those with a pyrexia after 48 h, one of nine blood cultures and two of 11 urine cultures grew organisms. Five pyrexial patients and one apyrexial patient developed a wound infection (a non-significant difference, P = 1.00). CONCLUSIONS Pyrexia within 48 h of EVAR is common. Microbiological investigation in the first 48 h in these patients is unrewarding. After 48 h, cultures are more likely to show growth. Although each patient must be assessed clinically for signs of sepsis, blood and urine cultures within 48 h of EVAR are generally unnecessary.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections

“…12 Post-implantation syndrome, characterised by transitory fever associated with elevated leukocytes and CRP may be observed following endograft implantation, but might also be distinguishing from an actual infection. 13 2.7. Microbiology and sampling techniques 2.7.1.…”

“…54 In another prospective study, patients undergoing aorto-iliac surgery were screened for S. aureus nasal carriage and, if positive, were treated with mupirocin nasal ointment and chlorhexidine body washes, and compared with a historical control group of patients who tested positive but received no treatment. The incidence of S. aureus SSI was significantly lower in patients who were screened positive and who were treated for methicillin resistant S. aureus (MRSA) nasal carriage compared with patients negative for nasal MRSA carriage (0% vs. 13.6%). 55 In addition, both 30 day mortality reintervention rates were significantly lower in the treated group (1.3% vs. 13.6%).…”

“…The incidence of S. aureus SSI was significantly lower in patients who were screened positive and who were treated for methicillin resistant S. aureus (MRSA) nasal carriage compared with patients negative for nasal MRSA carriage (0% vs. 13.6%). 55 In addition, both 30 day mortality reintervention rates were significantly lower in the treated group (1.3% vs. 13.6%). 55 Of note, S. aureus eradication in this setting was associated with a decrease in S.aureus related SSIs but not in the SSIs due to other bacteria, which may be explained by the competing behaviour of bacteria causing SSI.…”

Postimplantation Syndrome after Endovascular Aneurysm Repair

“…In the presence of fever and inflammatory parameters in the early postoperative period, patients usually undergo a work-up for possible infection, typically including chest radiography, urinalysis, urine culture and blood culture [32]. Some argue that this may be costly and unnecessary in clinical absence of an infection source [33]. However, since consequences of a serious postoperative infection may be devastating, at least close observation is recommended.…”

Complications and Perioperative Management of Patients Undergoing Thoracic Endovascular Aortic Repair

“…80 The clinical significance of this constellation of inflammatory findings is only starting to be explained, with infectious causes being extremely rare. 79,84 Postimplantation syndrome was initially thought to be a self-limited reaction 45 ; however, patients who develop the syndrome have increased rates of acute renal insufficiency, 82 prolonged length of stay, 80 and higher mortality. 46 In the largest study of clinical outcomes of PIS, both elevation in CRP and fever were found to predict combined major adverse cardiovascular events (MACEs), including cardiovascular death, myocardial infarction CVA, and transient ischemic attack.…”