Infectious aortitis has a significantly higher mortality rate compared with noninfectious aortitis, and initial antibiotic therapy may be protective against infectious aortitis. These findings were published in Clinical Infectious Diseases.

A retrospective study was conducted in 10 hospitals in southern France from January 1, 2014, to December 31, 2019. Eligible participants were aged older than 18 years and diagnosed with aortitis.

The primary outcome was the comparison of radiologic, clinical, and biological characteristics of infectious aortitis and noninfectious aortitis. Secondary outcomes were the comparison of mortality in infectious aortitis and noninfectious aortitis and analysis of risk factors for mortality in infectious aortitis.


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The cohort included 183 patients (median age, 69 years [IQR, 61-78 years]; 51.3% women). Infectious aortitis was diagnosed in 66 participants and 117 participants had noninfectious aortitis. A microbiological diagnosis was made in 83.3% of cases, and 5 cases had 2 different isolated microorganisms.

Among the 60 microorganisms that were identified, the most common were Enterobacterales (20%), Streptococcus spp (20%), Staphylococcus aureus (15%), and Coxiella burnetii (11.7%).

In the noninfectious aortitis group, 56.4% of cases were related to systemic disease, 37.6% to primarily giant cell arteritis, and 5.1% to Takayasu arteritis. More than one-third of participants presented with idiopathic aortitis (39.3%).

Patients with infectious aortitis had more cardiovascular comorbidities and were mostly men (75.8%). Symptom onset occurred less than 1 month before a diagnosis of aortitis in 86.4% of patients with infectious aortitis and 50% of patients with noninfectious aortitis (P <.001). Patients with infectious aortitis had abdominal pain more frequently (47.6% vs 29.9%, respectively; P =.021) and headache less frequently (9.1% vs 28.2%; respectively, P =.002) than patients with noninfectious aortitis.

The infrarenal aorta was involved in 60.6% of infectious aortitis cases and 17.9% of noninfectious aortitis cases (P <.001). Involvement of aortic branches was more common in noninfectious aortitis (50% vs 15.2%, respectively; P <.001), and abdominal arteries were more frequently involved in infectious aortitis (60% vs 12.1%, respectively; P =.001). Aneurysms were diagnosed in 78.8% of infectious aortitis cases vs 17.6% of noninfectious aortitis cases (P <.001).

Median follow-up was 660 days (IQR, 248-992) for the infectious aortitis group and 1095 days (IQR, 489-1491) for the noninfectious aortitis group. Survival was significantly decreased for patients with infectious aortitis vs those with noninfectious aortitis in univariate analysis (hazard ratio [HR], 3.95 [1.97-7.91], P <.001), as well as in multivariate analysis after adjustment for age, sex, and Charlson Comorbidity Index score (HR, 3.1 [1.38-6.98], P =.006). Aortitis-related mortality was significantly higher for infectious aortitis (12 cases) vs noninfectious aortitis (3 cases; Gray test P <.001).

Patients with infectious aortitis had a 30-day hospital mortality of 10.6%. Mortality was significantly associated with a higher American Society of Anesthesiologists score (HR, 2.47; 95% CI, 1.08-5.66; P =.033) and free aneurysm rupture (HR, 9.54; 95% CI, 1.04-87.11; P =.046) after adjustment for age, sex, and Charlson Comorbidity Index score. Initial effective antimicrobial therapy was protective (HR, 0.23 (0.08-0.71); P =.01), and no significant difference was observed for microorganisms and surgical technique.

Study limitations include the retrospective design, and that some deaths may have been unreported. Also, in the multivariate analysis, other confounding factors may not have been taken into account, and a prospective study would be more appropriate to study the mortality risk factors.

“To our knowledge, this study is the first to show a significant association between survival and initial antimicrobial therapy efficacy, which highlights the great importance of appropriate empiric treatment,” the study authors wrote. “Therefore, there is an urgent need for consensus on [infectious aortitis] antimicrobial therapy, both empiric and targeted.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Carrer M, Vignals C, Berard X, et al. Retrospective multicentric study comparing infectious and non-infectious aortitis. Clin Infect Dis. Published online July 6, 2022. doi: 10.1093/cid/ciac560