Recommendations on Securing Microbiological Specimens to Guide the Multidisciplinary Management of Infective Native Aortic Aneurysms

BACKGROUND: The absence of recommendations for the systematic collection of microbiological specimens to help determine the management of infective native aortic aneurysms (INAAs) may lead to diagnostic difficulty and suboptimal antibiotic treatment. In this review, we attempt to establish recommendations in the field by identifying current strategies for the diagnosis and management of INAA and comparing them with those for infective endocarditis (IE).

METHODS: A systematic literature review of Medline and ScienceDirect databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)methodology to identify guidelines for the management of INAA. These guidelines were scrutinized for recommendations concerning the procurement of microbiological specimens according to a defined protocol and involvement of specialists in infectious diseases and compared with current practice for IE.

RESULTS: Three guidelines were found to have sections dedicated to INAA. Of these, none provided any recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes. The guidelines from the American Heart Association recommend that patients with INAA should be managed by a team of specialists (including representation from the fields of infectious diseases and/or microbiology). Current guidelines for the investigation and management of IE provide detailed recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes, as well as the involvement of specialists in infectious medicine in multidisciplinary management.

CONCLUSION: This article emphasizes the absence of recommendations for the optimal diagnosis and management of patients with INAAs. While specific research is required to create evidence-based recommendations, application of strategies to identify microorganisms and multidisciplinary team management derived from the management of IE may be both safe and appropriate for the clinical management of this highly complex and heterogeneous group.