Suppurative thrombophlebitis in children: a ten-year experience

Septic discitis and septic pulmonary emboli: rare complications of Proteus mirabilis urinary tract infection

Proteus mirabilis is a gram-negative bacterium frequently considered a pathogen of the urinary tract. Septic discitis and septic pulmonary emboli resulting from P. mirabilis urosepsis is a rare phenomenon. We report a 39-year-old woman who was admitted to our hospital with a complicated urinary tract infection resulting in bacteraemia, septic discitis, paraspinal abscesses and septic emboli. She was treated with a prolonged course of intravenous antibiotics resulting in the clinical resolution of her symptoms. Based on our PubMed search of the English literature, this is only the second reported case of septic discitis caused by P. mirabilis This paper illustrates that physicians should include septic discitis caused by P. mirabilis as a possible aetiology of low back pain in patients with active or recently treated urinary tract infection. Additionally, this article discusses the pathogenesis and other complications resulting from P. mirabilis bacteraemia.

Candida thrombophlebitis in children: a systematic review of the literature

Objective

To describe a case of thrombophlebitis associated with Candida infection and to analyze other published reports to define clinical characteristics, prognostic data, diagnostic and therapeutic strategies.

Study design

A computerized search was performed without language restriction using PubMed and Scopus databases. An article was considered eligible for inclusion if it reported cases with Candida thrombophlebitis. Our case was also included in the analysis.

Results

A total of 16 articles reporting 27 cases of Candida thrombophlebitis were included in our review. The median age of patients was 4 years. In 10 cases there was a thrombophlebitis of peripheral veins; in the remaining cases the deep venous circle was interested. Candida albicans was the most frequently involved fungal species. The most recurrent risk factors were central venous catheter (19/28), broad spectrum antibiotics (17/28), intensive care unit (8/28), surgery (3/28), mechanical assisted ventilation (5/28), total parenteral nutrition (8/28), cancer (2/28), premature birth (6/28), cystic fibrosis (2/28). Fever was the most frequent clinical feature. All children with peripheral and deep thrombophlebitis were given antifungal therapy: amphotericin B was the most used, alone or in combination with other antifungal drugs. Heparin was most frequently used as anticoagulant therapy. Illness was fatal in two cases.

Conclusion

Candida thrombophlebitis is a rare but likely underdiagnosed infectious complication in pediatric critically ill patients. It is closely connected to risk factors such as central venous catheter, hospitalization in intensive care unit, prematurity, assisted ventilation, chronic inflammatory diseases. Antifungal therapy and anticoagulant drugs should be optimized for each patient and surgical resection is considered in the persistence of illness.

Extracardiac Complications in Intensive Care Units after Surgical Repair for Congenital Heart Disease: Imaging Review with a Focus on Ultrasound and Radiography

Pediatric patients show various extracardiac complications after cardiovascular surgery, and radiography and ultrasound are routinely performed in the intensive care unit to detect and evaluate these complications. This review presents images of these complications, sonographic approach, and timing of occurrence that are categorized based on their extracardiac locations and include complications pertaining to the central nervous system, mediastinum, thorax and lung parenchyma, diaphragm, liver and biliary system, and kidney along with pleural effusion and iatrogenic complications. This pictorial review will make it easier for medical doctors in intensive care units to identify and manage various extracardiac complications in pediatric patients after cardiovascular surgery.

Catheter-Related Staphylococcus aureus Bacteremia and Septic Thrombosis: The Role of Anticoagulation Therapy and Duration of Intravenous Antibiotic Therapy

Background

Catheter-related septic thrombosis is suspected in patients with persistent central line–associated bloodstream infection (CLABSI) after 72 hours of appropriate antimicrobial therapy. The clinical diagnosis and management of this entity can be challenging as limited data are available. We retrospectively studied the clinical characteristics of patients with Staphylococcus aureus catheter-related septic thrombosis and the outcomes related to different management strategies.

Methods

This retrospective study included patients with CLABSI due to S. aureus who had concomitant radiographic evidence of catheter site thrombosis treated at our institution between the years 2005 and 2016. We collected data pertaining to patients’ medical history, clinical presentation, management, and outcome within 3 months of bacteremia onset.

Results

A total of 128 patients were included. We found no significant difference in overall outcome between patients who had deep vs superficial thrombosis. Patients with superficial thrombosis were found to have a higher rate of pulmonary complications (25% vs 6%; P = .01) compared with those with deep thrombosis. Patients who received less than 28 days of intravascular antibiotic therapy had higher all-cause mortality (31 vs 5%; P = .001). A multivariate logistic regression analysis identified 2 predictors of treatment failure: ICU admission during their illness (odds ratio [OR], 2.74; 95% confidence interval [CI], 1.08–6.99; P = .034) and not receiving anticoagulation therapy (OR, 0.24; 95% CI, 0.11–0.54; P < .001).

Conclusions

Our findings suggest that the presence of S. aureus CLABSI in the setting of catheter-related thrombosis may warrant prolonged intravascular antimicrobial therapy and administration of anticoagulation therapy in critically ill cancer patients.

Diagnostic approach in persistent Staphylococcus aureus bacteraemia

Staphylococcus aureus is the leading cause of bacteraemia and can lead to complicated infections that may be difficult to diagnose and hence lead to higher morbidity. Failure to identify such could lead to severe complications or relapsing bacteraemia due to inadequate treatment. The authors report a patient presenting with methicillin-resistant S. aureus (MRSA) bacteraemia and septic arthritis, who developed a complicated infection with multiple metastasis and persistent bacteraemia despite adequate treatment. A fluorodeoxyglucose (FDG)-positron emission tomography scan 2 weeks after the initial presentation identified a linear area of intense FDG uptake within the right upper extremity which raised suspicion for an infected thrombus within the right cephalic vein. Adequate treatment of the infected thrombus helped resolve the patient's persistent MRSA bacteraemia and complicated infection. This case highlights the importance of considering suppurative thrombophlebitis in the setting of persistent bacteraemia and metastatic infections due to MRSA.

Extravasation injuries in adults

Insertion of an intravascular catheter is one of the most common invasive procedures in hospitals worldwide. These intravascular lines are crucial in resuscitation, allow vital medication to be administered, and can be used to monitor the patients' real-time vital parameters. There is, however, growing recognition of potential risks to life and limb associated with their use. Medical literature is now replete with isolated case reports of complications succinctly described by Garden and Laussen (2004) as "An unending supply of "unusual" complications from central venous catheters." This paper reviews complications of venous and arterial catheters and discusses treatment approaches and methods to prevent complications, based on current evidence and endeavours to provide information and guidance that will enable practitioners to prevent, recognise, and successfully treat extravasation injuries in adults.

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America

These updated guidelines replace the previous management guidelines published in 2001. The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them.

Complications of vascular catheters in the neonatal intensive care unit

Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU. With every passing decade, technological innovations in catheter materials and sizes have allowed vascular access in infants who are smaller and sicker for purposes of blood pressure monitoring, blood sampling, and infusion of intravenous fluids and medications. There is, however, growing recognition of potential risks to life and limb associated with the use of intravascular catheters. This article reviews complications of venous and arterial catheters in the neonatal ICU and discusses treatment approaches and methods to prevent such complications, based on current evidence.

Superficial Thrombophlebitis

Superficial thrombophlebitis (STP) is a common disease usually characterized by an auto-resolving vasculitis of medium-sized veins of the upper subcutis or deep dermis that clinically manifests as a tender or painful palpable cord-like structure. It usually occurs in the setting of varicous veins, or hypercoagulable states, and may be the alarm signal for an underlining silent cancer. STP mainly involves the legs, but special locations, including the anterior chest wall or the penis, characterize specific clinical forms (Mondor's disease). The clinical signs and symptoms usually allow an easy diagnosis, but complementary techniques and biopsy are sometimes required. The main histopathologic differential diagnosis of STP is cutaneous polyarteritis nodosa.

Guidelines for the management of intravascular catheter-related infections

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.

Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.

Superficial suppurative thrombophlebitis in children, caused by anaerobic bacteria

OBJECTIVE

The purpose of this study was to present the microbiology and clinical features of six children with superficial suppurative thrombophlebitis (SST) caused by anaerobic bacteria.

METHODS

A retrospective review of microbiological and clinical data was undertaken.

RESULTS

Anaerobic bacteria alone were recovered in four instances, and they were mixed with facultative bacteria in two. There were 12 bacterial isolates (10 anaerobic and 2 facultatives). The bacteria were Peptostreptococcus species (four isolates), Prevotella species (three), and one isolate each of Fusobacterium nucleatum, Propionibacterium acnes, Staphylococcus aureus, and Staphylococcus epidermidis. SST at an intravenous infusion site developed in all but one patient. One patient sustained trauma to the leg, and cellulitis developed. Anaerobes of oral origin (Prevotella and Fusobacterium species) were recovered in scalp vein SST, and of gastrointestinal origin (Bacteroides fragilis) in a lower extremity SST.

CONCLUSION

This study highlights the potential importance of anaerobic bacteria in children with SST.