Septic Thrombophlebitis

Diagnosis

Infected veins, they often present with sustained fevers and persistent bacteremia.


Epidemiologic Risks

Cannulating the vein, either for a medical reason or the use of drugs. As if the two are different.

There is also the infected fibrin sheath, that is left behind after the central line is pulled and can only be diagnosed on TEE (PubMed).

There is superficial and deep septic thrombophlebitis.

It can occur postpartum and as a complication of intra-abdominal infections.


Microbiology

S. aureus tends to predominate (it ain't called coagulase positive staph for nuthin'; it sure likes to cause clot) but any organism that can cause a catheter infection can lead to an infected clot.

Clot of the internal jugular is Lemmiers and often due to F. necrophorum. A complication of sore throat.

Clot in the hepatic vein is pylephlebitis, often due to E. coli.


Empiric Therapy

For peripheral thrombophlebitis, the vein needs to be resected. Usually. In the IVDA, 7 days of IV antibiotics followed by po will often work (PubMed).

For septic thrombophlebitis of the great vessels, anticoagulation. Antibiotics depend on what grows in the blood.

Duration? Longer is likely better than shorter, but you will have to decide when the patient is cured. I tend to treat like endocarditis.


Curious Cases

Relevant links to my Medscape blog

Which came first?

For want of a nail

Clot Happens

A Surfeit of Diseases, a Paucity of Letters

Clot

Real World, Perfect World

Making Do

Man was I in error yesterday

Infected Clot?

Goldberg

Last Update: 03/08/19.