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.

Details

Title
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
Author
Calderón-Parra, Jorge 1 ; Domínguez, Fernando 2 ; González-Rico, Claudia 3 ; Francisco Arnaiz de las Revillas 3 ; Goenaga, Miguel Ángel 4 ; Alvarez, I 4 ; Muñoz, Patricia 5 ; Alonso, David 5 ; Rodríguez-García, Raquel 6 ; Miró, José María 7 ; Arístides De Alarcón 8 ; Antorrena, Isabel 9 ; Goikoetxea-Agirre, Josune 10 ; Moral-Escudero, Encarnación 11 ; Ojeda-Burgos, Guillermo 12 ; Ramos-Martínez, Antonio 1 ; Fernando Fernández Sánchez; José Mª García de Lomas; Rosas, Gabriel; Javier de la Torre Lima; Bereciartua, Elena; Blanco Vidal, María José; Blanco, Roberto; Boado, María Victoria; Marta Campaña Lázaro; Crespo, Alejandro; Laura Guio Carrión; Mikel Del Álamo Martínez de Lagos; Gorane Euba Ugarte; Ane Josune Goikoetxea; Marta Ibarrola Hierro; Iruretagoyena, José Ramón; Josu Irurzun Zuazabal; López-Soria, Leire; Montejo, Miguel; Nieto, Javier; Rodrigo, David; Rodríguez, Regino; Vitoria, Yolanda; Voces, Roberto; García López, Mª Victoria; Radka Ivanova Georgieva; Ojeda, Guillermo; Isabel Rodríguez Bailón; Josefa Ruiz Morales; Ignacio Álvarez Rodríguez; Galparsoro, Harkaitz Azkune; Boronat, Elisa Berritu; Mª Jesús Bustinduy Odriozola; Cristina del Bosque Martín; Echeverría, Tomás; Alberto Eizaguirre Yarza; Fuentes, Ana; Muskilda Goyeneche del Río; Ángela Granda Bauza; Iribarren, José Antonio; Urkola, Xabier Kortajarena; Pérez-Moreiras López, José Ignacio; Ainhoa Rengel Jiménez; Reviejo, Karlos; Alberto Sáez Berbejillo; Elou Sánchez Haza; Rosa Sebastián Alda; Itziar Solla Ruiz; Irati Unamuno Ugartemendia; Diego Vicente Anza; Iñaki Villanueva Benito; Mar Zabalo Arrieta; Carrasco, Rafael; Climent, Vicente; Llamas, Patricio; Merino, Esperanza; Plazas, Joaquín; Reus, Sergio; Alonso, Alicia; Bouzas, Alberto; Castelo, Brais; Cuenca, José; Gutiérrez, Laura; Ramos, Lucía; María Rodríguez Mayo; Serrano, Joaquín Manuel; Dolores Sousa Regueiro; Martínez, Francisco Javier; Mª del Mar Alonso; Castro, Beatriz; Teresa Delgado Melian; Javier Fernández Sarabia; Dácil García Rosado; Julia González González; Lacalzada, Juan; Lissete Lorenzo de la Peña; Alina Pérez Ramírez; Pablo Prada Arrondo; Fermín Rodríguez Moreno; Antonio Plata Ciezar; José Mª Reguera Iglesias; Víctor Asensi Álvarez; Costas, Carlos; de la Hera, Jesús; Jonnathan Fernández Suárez; Lisardo Iglesias Fraile; Víctor León Arguero; José López Menéndez; Pilar Mencia Bajo; Morales, Carlos; Alfonso Moreno Torrico; Palomo, Carmen; Begoña Paya Martínez; Ángeles Rodríguez Esteban; Raquel Rodríguez García; Mauricio Telenti Asensio; Almela, Manuel; Ambrosioni, Juan; Azqueta, Manuel; Brunet, Mercè; Bodro, Marta; Cartañá, Ramón; Cuervo, Guillermo; Falces, Carlos; Fernández-Pittol, Mariana J; Fita, Guillermina; Fuster, David; Cristina García de la Mària; García-Pares, Delia; Hernández-Meneses, Marta; Jaume Llopis Pérez; Marco, Francesc; Miró, José M; Moreno, Asunción; Nicolás, David; Ninot, Salvador; Quintana, Eduardo; Paré, Carlos; Pereda, Daniel; Pericás, Juan M; Pomar, José L; Ramírez, José; Roque, Mercè; Rovira, Irene; Sandoval, Elena; Sitges, Marta; Soy, Dolors; Téllez, Adrián; Tolosana, José M; Vidal, Bárbara; Vila, Jordi; Adán, Iván; Alonso, Juan Carlos; Álvarez-Uría, Ana; Bermejo, Javier; Bouza, Emilio; Caballero, Gregorio Cuerpo; Antonia Delgado Montero; Estévez, Agustín; Ramón Fortuny Ribas; Gargallo, Esther; Mª Eugenia García Leoni; Ana González Mansilla; González Moraga, Francisco Javier; Víctor González Ramallo; Martha Kestler Hernández; Amaia Mari Hualde; Machado, Marina; Marín, Mercedes; Martínez-Sellés, Manuel; Melero, Rosa; Monzón, Diego; Olmedo, María; Pedraz, Álvaro; Pinilla, Blanca; Pinto, Ángel; Rincón, Cristina; Rodríguez-Abella, Hugo; Rodríguez-Créixems, Marta; Sánchez-Pérez, Eduardo; Segado, Antonio; Toledo, Neera; Valerio, Maricela; Vázquez, Pilar; Eduardo Verde Moreno; de la Villa, Sofía; Loeches, Belén; Moreno, Mar; Ramírez, Ulises; Verónica Rial Bastón; Romero, María; Rosillo, Sandra; Jesús Agüero Balbín; Cristina Amado Fernández; Castillo, Carlos Armiñanzas; Manuel Cobo Belaustegui; Fariñas, María Carmen; Fariñas-Álvarez, Concepción; Marta Fernández Sampedro; García, Iván; Claudia González Rico; Gutiérrez-Fernández, Laura; Gutiérrez-Cuadra, Manuel; José Gutiérrez Díez; Pajarón, Marcos; Parra, José Antonio; Teira, Ramón; Zarauza, Jesús; Jorge Calderón Parra; Cobo, Marta; Pablo García Pavía; Ana Fernández Cruz; Isabel Sánchez Romero; Centella, Tomasa; Hermida, José Manuel; Moya, José Luis; Martín-Dávila, Pilar; Navas, Enrique; Oliva, Enrique; Alejandro del Río; Jorge Rodríguez-Roda Stuart; Ruiz, Soledad; Carmen Hidalgo Tenorio; Sequera, Sergio; Delia, Manuel Almendro; Araji, Omar; José Miguel Barquero; Román Calvo Jambrina; de Cueto, Marina; Juan Gálvez Acebal; Méndez, Irene; Morales, Isabel; López-Cortés, Luis Eduardo; Arístides de Alarcón; Gutiérrez-Carretero, Encarnación; Lepe, José Antonio; López-Haldón, José; Luque-Márquez, Rafael; Marín, Guillermo; Ortiz-Carrellán, Antonio; Sánchez-Domínguez, Eladio; Alonso, Luis Javier; Azcárate, Pedro; Azcona Gutiérrez, José Manuel; Blanco, José Ramón; Estíbaliz Corral Armas; García-Álvarez, Lara; Oteo, José Antonio; Antonio Barros Membrilla; Iglesias, Antonino Ginel; Grillo, Sara; Rubén Leta Petracca; López-Contreras, Joaquín; María Alba Rivera Martínez; Álvarez, M; Fernández, A L; Martínez, Amparo; Prieto, A; Regueiro, Benito; Tijeira, E; Vega, Marino; Amaia Aguirre Quiñonero; Ángela Alonso Miñambres; Juan Carlos Gainzarain Arana; Sara González de Alaiza Ortega; Morán Rodríguez, Miguel Ángel; Anai Moreno Rodríguez; Zuriñe Ortiz de Zárate; José Joaquín Portu Zapirain; Ester Sáez de Adana Arroniz; Daisy Carolina Sorto Sánchez; Sánchez-Porto, Antonio; Úbeda Iglesias Alejandro; José Mª Arribas Leal; Elisa García Vázquez; Alicia Hernández Torres; Blázquez, Ana; Gonzalo de la Morena Valenzuela; Alonso, Ángel; Aramburu, Javier; Calvo, Felicitas Elena; Tarabini-Castellani, Paola; Eva Heredero Gálvez; Carolina Maicas Bellido; José Largo Pau; Sepúlveda, Mª Antonia; Pilar Toledano Sierra; Sadaf Zafar Iqbal-Mirza; Eva Cascales Alcolea; Yañez, Ivan Keituqwa; Julián Navarro Martínez; Ana Peláez Ballesta; Eduardo Moreno Escobar; Alejandro Peña Monje; Valme Sánchez Cabrera; David Vinuesa García; María Arrizabalaga Asenjo; Carmen Cifuentes Luna; Juana Núñez Morcillo; Mª Cruz Pérez Seco; Aroa Villoslada Gelabert; Guallar, Carmen Aured; Nuria Fernández Abad; Pilar García Mangas; Marta Matamala Adell; Mª Pilar Palacián Ruiz; Porres, Juan Carlos; Begoña Alcaraz Vidal; María Jesús Del Amor Espín; Buendía, Francisco; Roberto Jiménez Sánchez; Mármol, Rosario; Martínez, Francisco; Meseguer, Antonio; Pérez, Beatriz; Risco, Leticia; Saura, Zoser; Silva, Vanina; Villmarín, Mª Belén; Mª Ángels Ribas Blanco; Enrique Ruiz de Gopegui Bordes; Laura Vidal Bonet; Miquel Vives Borràs; Mª Carmen Bellón Munera; Elena Escribano Garaizabal; Antonia Tercero Martínez; Segura Luque, Juan Carlos; Badía, Cristina; Lucía Boix Palop; Xercavins, Mariona; Sónia Ibars Xerach Bosch; Eloy Gómez Nebreda; Ibalia Horcajada Herrera; Irene Menduiña Gallego; Pulido, Imanol; Héctor Marrero Santiago; de Miguel Martínez, Isabel; Álamo, Elena Pisos; San Román Sánchez, Daniel; Jorge Boan Pérez; Eva Mª Aguilar Blanco; Mercedes Catalán González; María Angélica Corres Peiretti; Esteve, Andrea Eixerés; Laura Domínguez Pérez; Santiago de Cossío Tejido; Francisco Galván Román; García Robles, José Antonio; Francisco López Medrano; Mª Jesús López Gude; Mª Ángeles Orellana Miguel; Pilkington, Patrick; Yolanda Revilla Ostalaza; Juan Ruiz Morales; Sebastián Ruiz Solís; Collado, Ana Sabín; Marcos Sánchez Fernández; Javier Solera Rallo; Jorge Solís Martín Francesc Escrihuela-Vidal; Carratalà, Jordi; Grau, Inmaculada; Ardanuy, Carmen; Berbel, Dámaris; Sánchez Salado, José Carlos; Alegre, Oriol; Alejandro Ruiz Majoral; Sbraga, Fabrizio; Blasco, Arnau; Laura Gracia Sánchez; Iván Sánchez-Rodríguez Gonzalo Aldamiz; Álvarez, Beatriz; Marina Bernal Palacios; Alfonso Cabello Úbeda; Ricardo Fernández Roblas; Hernández, Rafael; Victoria Andrea Hortigüela Martín; Kallmeyer, Andrea; Cristina Landaeta Kancev; Martín, Marta; Miguel Morante Ruiz; Navas Lobato, Miguel Ángel; Pello, Ana María; Prieto, Laura; Marta Tomás Mallebrera; Laura Varela Mireia de la Peña Triguero; Ruth Esther Figueroa Cerón; Lara Ruiz Gómez Mireia Ble; Juan Pablo Horcajada Gallego; Ginel, Antonio José; López, Inmaculada; Mas, Alexandra; Mestres, Antoni; Molina, Lluís; Serrat, Ramón; Ribas, Núria; Sánchez, Francisca; Silverio, Ana; Suárez, Marina; Sorlí, Luisa; Recasens, Lluís; Manuel Taurón María Fernández Regueras; María Ángeles Mantecón Vallejo; Pérez Rivera, José Ángel; Nuria Sánchez Mata Antonia Calvo Cano; Miguel Fajardo Olivares; Millán Núñez, María Victoria; Agustín Muñoz Sanz

1  Infectious Diseases Unit, Department of Internal Medicine, Puerta de Hierro University Hospital , Majadahonda , Spain 
2  Research Institute Puerta de Hierro-Segovia de Arana (IDIPHSA) , Majadahonda , Spain 
3  Department of Infectious Diseases, University Hospital Marqués de Valdecilla, CIBER Infectious Diseases (CIBERINFEC, CB21/13/00068). Cantabria University , Santander , Spain 
4  Department of Infectious Diseases, OSI Donostialdea , San Sebastian , Spain 
5  Department of Microbiology and Infectious Diseases, University Hospital Gregorio Marañón, CIBER Respiratory Diseases (CIBERES, CB06/06/0058), Complutense University , Madrid , Spain 
6  Intensive Care Department, University Hospital of Asturias , Oviedo , Spain 
7  Department of Infectious Diseases, Clinic Hospital—IDIBAPS, University of Barcelona , Barcelona , Spain 
8  Infectious Diseases, Microbiology, and Parasitology Unit, University Hospital Virgen del Rocio, Seville University , Seville , Spain 
9  Cardiology Department, University Hospital La Paz- IDIPAZ , Madrid , Spain 
10  Infectious Diseases Department, University Hospital Cruces , Bilbao , Spain 
11  Internal Medicine Department, University Hospital Virgen de la Arrixaca , Murcia , Spain 
12  Infectious Diseases Unit, University Hospital Virgen de la Victoria , Malaga , Spain 
Publication year
2024
Publication date
Mar 2024
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofae121
ProQuest document ID
3170974877
Copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.