CC Nov 2015 Septic Thrombophlebitis

echoecho's version from 2015-12-11 13:58


Question Answer
Define?venous thrombosis and inflammation associated with bacteremia
In catheter-associated thrombophlebitis, the presence of what catheter serves as a nidus of infection?indwelling
What % of patients with peripheral or central venous catheters develop catheter-associated infections? Which patient type have higher observed numbers?0.5-1%; burn victims
Noncatheter-associated septic thrombophlebitis is much less common and may affect what sized veins? List examples of this?1) large veins 2) internal jugular vein (Lemierre syndrome); portal vein (pylephlebitis), inferior and superior vena cava or pelvic veins
Increasing age, associated with an increase in what also increases the risk of thrombophlebitis in general, also increases the risk of septic thrombophlebitis?1) chronic disease and 2) inflammatory conditions
List two exceptions to the above?1) Lemierre syndrome (usually occurring in young adults) 2) septic pelvic thrombophlebitis (typically seen in women of childbearing age)
List two other risk factors?1) steroid use 2) IV drug use
What is the most commonly implicated organism?Staphylococcus aureus
List other bacteria which can be implicated?1) enteric gram-negative bacteria (especially in cases of pylephlebitis) 2) enterococci
Lemierre syndrome is associated with what bacteria?Fusobacterium necrophorum
The presentation of septic thrombophlebitis is dependent upon what?location of infected vein
Patients with peripheral vein involvement have what s/s?pain and swelling over the infected vein as well as fever
Those with Lemierre syndrome most commonly have what s/s?sore throat and fever
Septic thrombophlebitis of deep veins signs and symptoms?persistent fever and no obvious source
What are the s/s in pylephlebitis? What may be the cause of these s/s?1) abdominal pain and jaundice 2) obstruction
Comment on lab studies seen in this septic thrombophlebitis?may be consistent with infection and inflammation (WBCs, elevated CRP) but are nonspecific for septic thrombophlebitis
Cultures of what may aid in dx?comparisons between peripheral cultures and catheter-tip blood cultures
What imaging scans of the suspected area of infected vein may demonstrate filling defects with associated inflammation when combined with a positive blood culture?contrast-enhanced CT scans
US is usually only helpful in the evaluation of what vein?internal jugular vein
What is the treatment for septic thrombophlebitis of peripheral veins?1) removal of the IV catheter 2) broad-spectrum antibiotics (usually IV x 7 days then 14 days of po antibiotics) 3) infections associated with endocarditis or osteomyelitis require longer courses of antibiotics (4-8 weeks)
In cases refractory to antimicrobial therapy, what may be required?excision of the involved veins
What can occur with immediate removal of tips of central venous catheters compared to peripheral IV catheters? Why?1) may result in septic emboli 2) because the tips of central venous catheters often have a free-floating sheet of infected fibrin
The above patient should be treated how?with antibiotic lock therapy or antibiotics through the infected catheter prior to removal if indicated, followed by broad-spectrum antibiotics for 3-4 weeks IV
When is oral therapy an option?those with negative blood cultures and no further signs of sepsis
*** Anticoagulation is often recommended. While case reports demonstrate improvement in cases of septic pelvic thrombophlebitis, what is the role of anticoagulation in Lemierre syndrome and other deep vein septic thrombophlebitis?it is not supported by strong evidence
*** SUMMARY = List the 2 types of septic thrombophlebitis?1) cathether related 2) non-catheter related
*** SUMMARY = How is septic thrombophlebitis of peripheral veins treated?1) removal of IV catheter 2) broad spectrum antibiotics (usually given IV x 7 days and followed by oral therapy x 14 days)
*** SUMMARY = Septic thrombophlebitis associated with what 2 disease states requires longer courses of antibiotics (4-8 weeks)?1) endocarditis 2) osteomylelitis