Global Bacterial Spectrum, Diagnostic Culture Yield, and Microbiology-Related Mortality Risk in Infective Native Aortic Aneurysm: A Systematic Review and Meta-Analysis.
Minyong Peng, Menglin Nie, Yida Cao et al.
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In 30 seconds
This systematic review and meta-analysis synthesized the bacterial spectrum, culture yield, concurrent infections, and microbiology-related mortality in infective native aortic aneurysm (INAA). The primary meta-analysis included 79 studies and 3,835 patients; additional culture-confirmed reports were used descriptively. Salmonella was the leading genus globally (30.6%), while Staphylococcus predominated in developed countries (30.8%) and Salmonella in developing countries (59.0%) and China (60.6%). Any microbiological detection was achieved in 64.9% (95% CI, 60.1-69.4%). Non-Salmonella-positive culture was associated with higher mortality (HR, 1.66; 95% CI, 1.14-2.42).
Key findings
- Across the descriptive dataset, Salmonella accounted for 30.6% of identified bacteria, followed by Staphylococcus (25.6%) and Streptococcus (11.8%).
- Staphylococcus predominated in developed countries (30.8%); Salmonella predominated in developing countries (59.0%) and China (60.6%).
- Any microbiological detection was achieved in 64.9% (95% CI, 60.1-69.4%; I2 = 82.0%).
- Non-Salmonella-positive culture was associated with higher mortality (HR, 1.66; 95% CI, 1.14-2.42); other reported culture categories were not statistically significant.
Why it matters
INAA has substantial mortality, and the review shows that its bacterial distribution varies by geography while cultures identify an organism in only about two-thirds of cases. These findings highlight the importance of interpreting microbiology in regional context and recognizing that negative cultures do not exclude infection. The reported mortality association also suggests that pathogen category may be relevant to risk assessment, although it does not establish causation.
What to keep in mind
The evidence was synthesized from heterogeneous studies, with high heterogeneity in overall microbiological detection (I2 = 82.0%). The mortality findings are associations and do not establish that pathogen type causes differences in outcome.