Citrobacter koseri Surgical Site Infection after Femoropopliteal Vein Bypass for Popliteal Artery Aneurysm Treated with a Graft Preserving Strategy

Background: A 69-year-old man underwent ligation and evacuation of a popliteal artery aneurysm with a femoral-to-popliteal vein bypass. He had a history of Citrobacter koseri prostatitis two months prior to the surgery. One month postoperatively, he presented with extremity swelling, redness, and fluid collections around the graft. Methods: A graft preserving strategy was adopted. The patient underwent operative drainage, washing, and received long-term antibiotic therapy. Fluid culture grew Citrobacter koseri, previously not reported as cause of surgical site infection with infrainguinal graft involvement. Results: The infection was treated successfully, and the patient is remains symptom free 18 months post-operatively. Conclusions: This case highlights the importance of considering culturing the aneurysm content in the presence of infectious history.