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Associations and outcomes of septic pulmonary embolism.

Goswami U, Brenes JA, Punjabi GV, LeClaire MM, Williams DN - Open Respir Med J (2014)

Bottom Line: Seven (17%) patients received systemic anticoagulants.Eight (20%) patients died due to various complications.Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.

ABSTRACT

Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies.

Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital.

Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013.

Results: 41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications.

Conclusion: The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.

No MeSH data available.


Related in: MedlinePlus

Microbiology and culture characteristics in 41 cases (40patients) with SPE.
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Figure 1: Microbiology and culture characteristics in 41 cases (40patients) with SPE.

Mentions: Presenting symptoms included a febrile illness (85%), pulmonary symptoms, most typically pleuritic chest pain (22%), cough (19%) and dyspnea (15%). Eight patients (19%) presented with septic shock. Thirteen patients (32%) were admitted directly to the medical intensive care unit because of the acuity of their illness, 8 (61%) of whom did not survive the hospitalization (Table 2). Identified comorbidities at the time of admission included IV drug abuse (IVDA) (15/41), end-stage renal disease (10/41), diabetes mellitus (7/41) and immunosuppressive states (3/41). A potential source of infection was identified in all but one patient. These included skin and soft tissue sites (cellulitis 1 case, infected skin ulcers 4 cases, deep subcutaneous abscess 13 cases) predominantly; followed by infective endocarditis, indwelling IV devices, and peripherally infected deep venous thrombosis (Fig. 1A). Microbiologic studies underscored the importance of staphylococcus aureus as the predominant cause (35 cases, 21 due to Methicillin Sensitive Staphylococcus aureus- MSSA and 14 Methicillin Resistant - MRSA) (Fig. 1B). Thirty seven patients had positive blood cultures (Fig. 1C).


Associations and outcomes of septic pulmonary embolism.

Goswami U, Brenes JA, Punjabi GV, LeClaire MM, Williams DN - Open Respir Med J (2014)

Microbiology and culture characteristics in 41 cases (40patients) with SPE.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150379&req=5

Figure 1: Microbiology and culture characteristics in 41 cases (40patients) with SPE.
Mentions: Presenting symptoms included a febrile illness (85%), pulmonary symptoms, most typically pleuritic chest pain (22%), cough (19%) and dyspnea (15%). Eight patients (19%) presented with septic shock. Thirteen patients (32%) were admitted directly to the medical intensive care unit because of the acuity of their illness, 8 (61%) of whom did not survive the hospitalization (Table 2). Identified comorbidities at the time of admission included IV drug abuse (IVDA) (15/41), end-stage renal disease (10/41), diabetes mellitus (7/41) and immunosuppressive states (3/41). A potential source of infection was identified in all but one patient. These included skin and soft tissue sites (cellulitis 1 case, infected skin ulcers 4 cases, deep subcutaneous abscess 13 cases) predominantly; followed by infective endocarditis, indwelling IV devices, and peripherally infected deep venous thrombosis (Fig. 1A). Microbiologic studies underscored the importance of staphylococcus aureus as the predominant cause (35 cases, 21 due to Methicillin Sensitive Staphylococcus aureus- MSSA and 14 Methicillin Resistant - MRSA) (Fig. 1B). Thirty seven patients had positive blood cultures (Fig. 1C).

Bottom Line: Seven (17%) patients received systemic anticoagulants.Eight (20%) patients died due to various complications.Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA.

ABSTRACT

Background: Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies.

Objective: To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital.

Methods: We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013.

Results: 41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications.

Conclusion: The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.

No MeSH data available.


Related in: MedlinePlus