What is the recommended antibiotic (Abx) therapy for a collection paraaortic post dissection repair?

Antibiotic Therapy for Paraaortic Collection Following Aortic Dissection Repair

Postoperative parenteral antimicrobial therapy for 4 to 6 weeks is recommended for paraaortic collections following aortic dissection repair. 1

Recommended Antibiotic Regimen

• Initial parenteral (IV) antibiotic therapy should be administered for 4-6 weeks to treat the paraaortic collection 1
• The antibiotic regimen should target common pathogens involved in vascular graft infections, including:
  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Gram-negative bacteria 1

Treatment Algorithm

Initial Management:

1. Obtain cultures before starting antibiotics when possible to guide targeted therapy 1
2. Begin empiric broad-spectrum antibiotics while awaiting culture results 1
3. Consider surgical consultation to evaluate whether drainage or surgical intervention is needed 1

Duration of Therapy:

• Short-term therapy: 4-6 weeks of parenteral antibiotics is the standard approach 1
• Extended therapy: For high-risk patients, oral antibiotic therapy for 3-6 months following the initial parenteral course may be considered 1
• Long-term therapy: In patients with high risk of morbidity and mortality who cannot tolerate extensive reconstructive surgery, lifelong suppressive antimicrobial therapy may be considered 1

Special Considerations

Surgical Management Options:

• In situ repair with cryopreserved arterial allografts is reasonable when surgical intervention is required 1
• If technically feasible, viable omentum or muscle flap coverage of the aortic repair site can promote healing and reduce infection 1

Risk Factors for Complications:

• Older age and increased BMI are associated with higher risk of acute respiratory dysfunction following aortic dissection repair 2
• Patients with paraaortic collections may require longer ICU stays and mechanical ventilation 2

Important Caveats

• The decision to administer extended oral antibiotic therapy or chronic suppressive therapy should be made in consultation with infectious disease specialists and the surgical team 1
• Broad-spectrum antibiotics have not shown improved outcomes compared to narrow-spectrum antibiotics in post-aortic dissection repair patients, and may be associated with higher rates of renal and neurological complications 2
• Regular imaging follow-up is essential after aortic dissection repair, with recommended intervals of imaging at 1,3,6, and 12 months after onset, then yearly if findings remain stable 1
• Fluoroquinolones should be used with caution in patients with aortic pathology as they have been associated with increased risk of aortic aneurysm and dissection 3

Follow-up Recommendations

• After open surgery for acute aortic syndrome, follow-up imaging by CCT and TTE within 6 months, then CCT at 12 months and yearly thereafter if findings remain stable 1
• If no complications occur within the first 5 years, CCT every 2 years thereafter should be considered 1
• Monitor for signs of recurrent infection, including fever, leukocytosis, or changes in inflammatory markers 1