Infections associated with vascular prostheses by Salmonella spp. are rare, severe, and described in cases of aortic aneurysms and after endovascular repair. Management involves surgical intervention and, in some cases, prolonged antibiotic therapy. Description: Male patient, 61 years old, hypertensive, diabetic, chronic kidney disease, former smoker. He underwent Nester coil embolizations of the internal iliac arteries in October 2021 and abdominal aneurysm repair with an Endurant endograft in November 2021. In April 2023, after aneurysm enlargement, he underwent aortography and arteriography to investigate type II endoleak, with unsuccessful correction, and a bifurcated prosthesis was maintained. He remained under conservative follow-up when, in September 2024, he developed fever. Initially, amoxicillin-clavulanate was prescribed for a pulmonary infection with tuberculosis ruled out. However, he remained febrile with an undetermined focus, progressing to hemodynamic instability and the need for vancomycin, meropenem, and polymyxin B, until blood cultures with multisusceptible Salmonella spp. indicated late infection of the aortoiliac endograft associated with bacteremia. Therapy was changed to ceftriaxone 2 g IV daily for 30 days, followed by suppressive therapy with sulfamethoxazole-trimethoprim 800/160 mg twice daily for 8 weeks, then 800/160 mg once daily indefinitely. Currently, after 7 months, the patient remains on the once-daily dose, afebrile since January, without alarm signs, and with negative blood cultures since November 2024. Recent tests show no changes secondary to prolonged sulfamethoxazole use. Imaging shows aneurysm stability. Endograft infections involve therapeutic challenges and, in most cases, surgical treatment is required. However, when surgical risk is high, antimicrobials associated with drainage of abscesses and collections should be the choice, including strategies of chronic suppressive antibiotic therapy aimed at preventing aneurysmal rupture or recurrent sepsis. There is no consensus on the ideal duration of treatment, considering high reinfection rates. In the present case, the absence of fever and other clinical complications and adverse effects related to prolonged sulfamethoxazole use; aneurysmal stability; and the possibility of strict clinical surveillance and scheduled imaging monitoring support continuation of the conservative approach.
Batista et al. (Sun,) studied this question.