Distinguishing Sterile Inflammation from Graft Infection

Abstract

Abstract Background: It is often difficult to distinguish a noninfectiousinflammatory response from infection in peri-graft fluid collection. The diagnosis of graft infection is usually based on clinical findings supported by the clinical course and radiological and microbiological investigations. Case presentation: We describe a 68-year-old man who underwent ascending aortic replacement and thoracic endovascular aortic repair. Four years later, the patient noticed right neck pain, and CT showed that the fluid in the mediastinum had expanded and extended to the neck. Echocardiography revealed progressive severity of aortic regurgitation and decreased ejection fraction. Given the progression of aortic regurgitation, decreased cardiac function, and rapidly expanding fluid collection causing neck pain, surgery was indicated. All microbiological tests, including polymerase chain reaction, were negative. The patient was being followed without antibiotics, and CT did not show peri-graft fluid 2 years postoperatively. Conclusions: We cannot exclude the infection completely, but we report the importance of medium selection, additional medium orders, extension of culture, genetic testing, and communication with microbiology laboratories when normal culture tests for general bacteria and fungi were all negative, which can successfully avoid increased drug-resistant bacteria count, elevated medical costs, and drug side effects due to the improper use of antibiotics through proper diagnosis.