Septic Phlebitis Research Articles

Septic phlebitis of the liver presenting as fever of unknown origin detected by FDG PET/CT.

Septic phlebitis of the liver presenting as fever of unknown origin detected by FDG PET/CT.

Gas in the Inferior Mesenteric Vein – successful non operative management of a rare complication of diverticulitis

Septic phlebitis (also known as pyelephlebitis) because of diverticulitis is a rare but important complication. Many previous cases have mandated urgent surgical management for fear of further deterioration. This case report details one of the first cases where septic phlebitis was successfully managed conservatively, and details important clinical lessons clinicians should be aware of.

A CASE OF MEDIASTINITS AND SEPTIC THROMBOPHLEBITIS SECONDARY TO SEPTIC STERNOCLAVICULAR JOINT ARTHRITIS

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Septic Sternoclavicular joint (SCJ) is a rare diagnosis. Certain risk factors such as diabetes mellitus have been associated with it. The most serious complication of this condition is mediastinits. CASE PRESENTATION: A 48-year-old male with history of type II diabetes mellitus presented with complaints of a progressively worsening left parasternal discomfort that started 3 days ago, which worsened with movement. He also described subjective fever, chills and diaphoresis at home. He denied upper respiratory symptoms. He has had no recent surgeries or instrumentation. He travelled recently to a but denied sick contacts. On presentation he was febrile, tachycardic, diaphoretic, hypertensive. His labs showed leukocytosis to 32000/mm3, a sodium level of 124 and elevated glucose of 484. On physical examination the patient had reproducible left shoulder and chest wall tenderness with palpation. Levaquin 750 mg intravenously was initiated along with supportive therapy. Computed Tomography (CT) of the chest showed anterior mediastinal fat infiltration consistent with mediastinitis and left sided pleural effusion. CT head and neck was ordered which showed inflammatory changes at the left thoracic inlet with involvement of adjacent mediastinal fat, with nonopacification of left subclavian vein and left innominate vein, suspicious for septic phlebitis and adjacent mediastinitis. Blood cultures grew methicillin-sensitive staphylococci. The patient was then started on cefazolin intravenously. Follow up blood cultures cleared and he was discharged on intravenous cefazolin for 4 weeks and outpatient follow up. DISCUSSION: SJC infection is rare occurring only about 0.5-1% of all infections [1]. Common causes include diabetes mellitus, intravenous drug use, trauma, immunosuppression, infected central lines among others. The clinical signs of SCJ septic arthritis are chest pain localizing to the SCJ (78 %), fever (65 %), and shoulder pain (24 %) and neck pain (2%) [1,2]. Joint swelling and overlying erythema is common. A CT scan of the chest or magnetic resonance imaging is recommended as the initial imaging study that helps identify bone destruction, however the final diagnosis is made from culture of the joint fluid obtained using needle aspiration or open biopsy. Common organisms that has been described are staphylococcus aureus coli, H influenza, Streptococcus pneumonia, streptococcus pyogenes [1,2]. The most potential and serious complication is mediastinitis, which occurs in less than 15% of cases [1,2] as in our case. Our case is unique because it also lead to septic thrombophelibitis of left subclavian vein. Antibiotics with or without drainage and surgical debridement is the treatment of choice. CONCLUSIONS: Sternoclavicular joint septic arthritis is a rare condition. Anterior mediastinitis and septic thrombophlebitis should be suspected as possible complications in uncontrolled diabetes. Reference #1: Ross JJ, Shamsuddin H. Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore). 2004;83(3):139-48. Reference #2: 2. Yood RA, Goldenberg DL. Sternoclavicular joint arthritis. Arthritis Rheum. 1980;23:232–9. DISCLOSURES: No relevant relationships by Janak Adhikari, source=Web Response No relevant relationships by Karim Anis, source=Web Response No relevant relationships by AHMET HAKKI KAPICI, source=Web Response No relevant relationships by Fnu Zafrullah, source=Web Response

Methicillin-Resistant Staphylococcus aureus: A Pharmacotherapy Primer

Methicillin-Resistant Staphylococcus aureus: A Pharmacotherapy Primer

Septic Phlebitis: A Dangerous Complication of Diverticulitis

Colonic diverticulitis is an inflammation of the colon due to microperforation of a diverticulum, a sac-like protrusion of the colonic wall. This digestive tract disease is most common among the elderly people and affects predominantly the distal portion of the colon (sigmoid and descending). Pericolonic abscess, fistula formation, perforation, luminal obstruction, and peritonitis are well-known complications of diverticulitis. One of the most rare fistulas is enterovascular, which is a communication between a blood vessel and adjacent bowel. An uncommon complication and threatening condition of perforated diverticula is septic phlebitis, in which perforation spreads to the mesentery and erodes a blood vessel. We report a case of septic phlebitis due to enterovascular fistula. This is the case of a 79 year-old female, Latin American, past medical history of diverticulosis, arterial hypertension, and lumbar disk herniation who presented with low back pain, abdominal pain, fever, and nausea; she was treated symptomatically and discharged home from a hospital of the metropolitan area. She returned due to persistence of symptoms and multiple episodes of bright red blood per rectum. On examination, patient was acutely ill with positive digital rectal exam for blood. She was admitted and placed NPO with high dose of proton pump inhibitors plus antibiotic therapy. Abdominopelvic CT scan with IV contrast was performed which showed acute sigmoid diverticulitis with abscess formation, nodular liver appearance, and left portal vein thrombosis. Blood cultures were done and showed anaerobic gram-negative bacilli consistent with Porphyromonas spp. During hospitalization, patient developed septic shock and acute respiratory failure that required vasopressor therapy and intubation, respectively. Abdominopelvic CT with PO and IV contrast was repeated which showed portal venous thrombosis with sigmoid/inferior mesenteric vein fistula. Bowel rest was given and total parenteral nutrition was started. Patient was given intravenous fluids and broadspectrum antibiotics; end colectomy with Hartmann's pouch and partial colectomy was done with significant improvement of symptoms. Patient was discharged home to complete physical therapy rehabilitation. Septic phlebitis of the inferior mesenteric vein is an unusual complication of diverticular disease. History, physical examination, and radiographic imaging are helpful in identifying this entity. Prompt radiologic imaging is detrimental to the diagnosis, treatment, and management of abdominal pathology. Surgical intervention in a rapidly manner can be lifesaving. Early diagnosis and treatment should be emergent due to high-risk mortality from this complication.Figure 1Figure 2Figure 3

Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy.

The purpose of this study is to evaluate the complications of peripherally inserted central catheters (PICCs) in orthopedic patients with chronic bone orthopedic infection. The institutional review board approved this retrospective study and informed consent was waived. Records of 180 consecutives PICCs placed in patients hospitalized in the orthopedic surgery department were reviewed. All patients had bones infections necessitating a long-term intravenous antibiotics therapy. All PICC complications were recorded during the patient hospitalization: infection [catheter-related bloodstream infection (CRBSI), central line associated bloodstream infection (CLABSI), exit-site infection, septic phlebitis], thrombosis, occlusion, mechanical complication (accidental withdrawal, malposition, median nerve irritation). One hundred and eighty PICCs were placed in 136 patients. Mean duration of catheterization was 21 days (total 3911 PICC-days). Thirty-six PICCs (20%) were removed due to complications (9.2 complications per 1000 PICC-days): 14 (8%) infections (one CRBSI (Pseudomonas aeruginosa), one septic phlebitis (P. aeruginosa), two exit-site infections and 10 CLABSIs), 11 (6%) occlusions, and 12 (7%) mechanical complications (10 accidental withdrawals, one malposition, one median nerve irritation). One patient had two complications simultaneously. After multivariate analysis, two risk factors were significantly associated with the overall occurrence of complications: age more than 70 years [OR = 2.89 (1.06-7.89], p = 0.04] and number of lumen at least two [OR = 2.64 (1.03-6.75), p = 0.04]. Even in orthopedic patients with chronic orthopedic bone infection, PICCs have a low rate of complication. The increasing lumen number of the PICC is a potential risk factor in our series.

Perioperative management of diabetic foot.

Perioperative management of diabetic foot.

Fulminant Hepatic Failure and Gas Gangrene Secondary to Clostridium Perfringens Septicemia

Purpose:Clostridium perfringens is an exotoxin producing bacteria, and can be found in the intestinal tract of humans. Their invasive nature as pathogens can be attributed to physical trauma or surgical procedures, with resulting evidence of myonecrosis. We present a unique case of fulminant liver failure with gas gangrene, pneumobilia, myonecrosis, and splenorenal shunt phlebitis in an Asian female, without recent history of physical trauma or surgery. An 81-year-old female with history of Diabetes Mellitus presented with acute complaints of fever and altered mental status. Exam was significant for an erythematous rash on the right knee, without evidence of trauma. Labs were significant for leukocytosis, elevated LFTs (AST/ALT >2600 IU/L), and coagulopathy. CT scan of the abdomen revealed two necrotic masses in the right hepatic lobe, pneumobilia, and splenorenal shunt septic phlebitis. Additionally, multiple areas of intramuscular air were noted within the gluteus maximums muscles. The patient was started on broad spectrum antibiotics but expired within 12 hours. Blood cultures revealed C. perfringens after 24 hours of incubation. C. perfringens, is a gram-positive, rod-shaped, anaerobic, spore forming bacterium. These environmental bacteria enter the muscle tissue via a wound, resulting in tissue necrosis and systemic spread. Gas gangrene found in the liver with fulminant hepatic failure is exceedingly rare, especially in constellation with pneumobilia, myonecrosis, and splenorenal shunt septic phlebitis. Management consists of medical therapy with penicillin and clindamycin. Aggressive surgical debridement and excision of affected tissue is vital to increasing the likelihood of survival. A few rare cases of spontaneous gas gangrene have been described in the literature attributed to C. perfringens. None have shown the manifestations of fulminant hepatic failure with gas gangrene along with pneumobilia, splenorenal shunt phlebitis, and myonecrosis without preceding surgery or physical trauma. The exact incidence of this infectious process remains unknown because it is rapidly progressing and is often unrecognized in the emergency setting. Hematogenous seeding of muscles with bacteria from a gastrointestinal tract port of entry should be entertained. Early detection and diagnosis, together with proper supportive treatment, can improve patient outcomes.Figure: [1008]

Diverticulitis as a cause of septic thrombophlebitis: A literature review

Introduction: Perforated diverticulitis, with fistula formation between the colon and inferior mesenteric vein, is a cause of portal venous gas. In contrast to more common causes of portal venous air, such as mesenteric ischemia and gangrene, the prognosis is much better for patients with perforated diverticulitis. However, the diagnosis can be difficult to make, given the wide range of nonspecific symptoms. Delays in diagnosis increase the morbidity and mortality rates. Case Report: In this report, we describe a case of perforated diverticulitis with portal venous gas in a 46­year­old male from our institution, and review the literature on this topic. Conclusion: With modern imaging technology and early diagnosis, septic phlebitis can be managed surgically, with good outcomes.

Air Inclusion in Suppurative Deep Venous Thrombosis

Septic or suppurative deep venous thrombosis is an uncommon but occasionally lethal disease due to systemic complications. In most cases, it is caused by intravenous drug use or by percutaneous insertion of central venous catheter lines in critically ill patients. 1-3 Some patients have septic phlebitis after delivery or abortion or as a late complication of local infections such as pyonephrosis. 4 Most patients are admitted with clinical signs of severe sepsis and occasionally with complications as a result of septic embolization. 2 We report the case of an intravenous drug user with septic deep venous thrombosis of the left common femoral and external iliac veins diagnosed by sonography.

Development of Daptomycin Nonsusceptibility with Heterogeneous Vancomycin-Intermediate Resistance and Oxacillin Susceptibility in Methicillin-Resistant Staphylococcus aureus during High-Dose Daptomycin Treatment

The use of daptomycin has increased in recent years, especially in patients with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia following vancomycin treatment failure (10). We report a case of persistent MRSA bacteremia in a patient who received a dosage of daptomycin (12 mg/kg body weight/day) that was higher than that of the recommended standard therapy (6 mg/kg/day) (2, 10). The patient received 4 weeks of teicoplanin followed by 5 months of oral linezolid prior to daptomycin. In addition to daptomycin nonsusceptibility, the causative strain also developed heterogeneous and intermediate resistance to vancomycin, and an inverse or “seesaw” effect of daptomycin nonsusceptibility and oxacillin susceptibility was noted. A 59-year-old man with stage IV non-Hodgkin's lymphoma was admitted for chemotherapy. Six days later, he developed catheter-associated septic phlebitis. Two sets of blood cultures (BCs) yielded MRSA (CGK1). Transesophageal ultrasound revealed no vegetation. Teicoplanin (800 mg/day) was initiated, and the patient's fever subsided. However, the hip magnetic resonance image (MRI) indicated left sacroiliac joint septic arthritis, and repeat BCs yielded MRSA (CGK2) after 4 weeks of teicoplanin. The patient chose to receive therapy at home. After 3 months of oral linezolid (1,200 mg/day), fever and MRSA bacteremia (CGK3) reoccurred on the second day after linezolid was discontinued, but the fever subsided immediately after restarting linezolid. MRSA bacteremia (CGK4) reoccurred after another 2 months. After the patient was readmitted, linezolid was replaced by parenteral daptomycin (700 mg/day; 12 mg/kg), but fever developed 12 days later. Peripheral vein and Port-A-Cath BCs both yielded MRSA (CGK5). The Port-A-Cath was removed, but fever and MRSA bacteremia persisted (CGK6). Transesophageal echocardiography performed on hospital day 26 revealed no vegetation, but MRI indicated infective spondylitis of the thoracic spine that was associated with a progressive infectious process on the left hip joint. On hospital day 35, daptomycin was replaced by parenteral linezolid (1,200 mg/day) and cefpirome (2 g every 12 h) because of persistent fever and refractory MRSA bacteremia (CGK7). BCs obtained 3 days after linezolid and cefpirome were started still grew MRSA (CGK8). Profound septic shock occurred thereafter, and the patient died on hospital day 45. All 8 isolates had indistinguishable pulsed-field gel electrophoresis patterns (data not shown) and shared the same genetic profile (sequence type 59 [ST59], staphylococcal cassette chromosome mec type IV [SCCmec IV], pvl negative, agr group I), indicating that the persistent bacteremia was due to the same strain of MRSA or its progeny. The MICs of daptomycin increased from ≤0.75 μg/ml in CGK1 through CGK5 to 4 μg/ml in CGK6 through CGK8. Concurrent with the increase in daptomycin MICs, oxacillin MICs decreased from 32 to >256 μg/ml to 1 to 3 μg/ml (Table ​(Table1).1). Vancomycin nonsusceptibility also developed in CGK7, with a MIC of 3 μg/ml, which fit the vancomycin-intermediate S. aureus (VISA) category (4). Population analysis profiles showed a distinct increased population of CGK6 through CGK8 able to grow at daptomycin concentrations of ≥2 μg/ml (Fig. ​(Fig.11 A), and only CGK7 met the heterogeneous VISA (hVISA) criteria (Fig. ​(Fig.1B)1B) (17). Sequencing of the mprF gene for all 8 isolates revealed an L431F amino acid substitution in CGK6 through CGK8, but no mutation was found in the sites (S295, P314, T345, I420) previously reported in other daptomycin-nonsusceptible strains (6-9, 11, 18). FIG. 1. Population analysis profiles (PAP) of daptomycin (A) and vancomycin (B) on 6 of 8 sequential methicillin-resistant Staphylococcus aureus (MRSA) isolates from a fatal, persistent bacteremia case. CGK1, CGK3, and CGK5 isolates were daptomycin susceptible, ... TABLE 1. MICs of daptomycin, linezolid, oxacillin, teicoplanin, and vancomycin for 8 MRSA isolates from a fatal, persistent bacteremia case prior to, during, and after high-dose daptomycin therapy Much remains to be elucidated on the mechanisms involved in daptomycin and associated vancomycin nonsusceptibility (1-3, 5-9, 12, 14, 18) and the inversed oxacillin susceptibility (13, 15, 16). Previous reports have emphasized the importance of draining infection foci for successful treatment outcomes (2, 10), but surgical intervention was not possible in our patient due to coagulopathy secondary to his non-Hodgkin's lymphoma. The causative strain, with initial vancomycin MICs (2 μg/ml) at the upper susceptible limit, and priming by glycopeptide exposure (in this case, teicoplanin) likely contributed to the development of daptomycin and vancomycin nonsusceptibility (2, 10). Until practical laboratory methods for timely detection of strains with heteroresistance or attenuated susceptibility are developed, close monitoring for the emergence of daptomycin nonsusceptibility during treatment is needed.

Septic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of Literature

Septic Phlebitis and Gas in the Inferior Mesenteric Vein: CT findings in Two Cases and Review of Literature

A 58-Year-Old Man With Episodically Widened Pulse Pressure

A 58-year-old man was admitted to the hospital with fevers, weakness, and dyspnea for 2 days. His medical history was significant for end-stage renal disease (dialysis three times weekly via arteriovenous [AV] graft), coronary artery disease status after myocardial infarction and stenting of a left anterior descending artery lesion 4 years prior, and ischemic cardiomyopathy with class III congestive heart failure. One year prior to this hospital admission, septic phlebitis and bacterial endocarditis related to an implanted cardioverter-defibrillator were treated with device removal, replacement of both aortic and mitral valves (St.

Lemierre’s syndrome: A potentially fatal complication that may require vascular surgical intervention

Septic phlebitis of the internal jugular vein, Lemierre's syndrome, is extremely rare. However, Lemierre's syndrome may cause septic pulmonary emboli or result in fatal systemic sepsis, or both, if a timely diagnosis and appropriate treatment are not provided. We present a case of Lemierre's syndrome that occurred in an otherwise healthy young man. In this case, progression to a moribund state was rapid, and surgical intervention proved lifesaving.

Ein auto-iatrogenes Leiden

A 55-year-old practitioner from an island in the northern sea felt an increasing hypersensitivity of his entire body to various ambient and nutritional allergens and toxics. He started to treat himself with increasing doses of glucocorticoids and moved to a southern climate in Lanzarote and later on to the Swiss mountains in the grisons. On admission to our hospital in December he was in a disastrous psychotic condition, trying to cool down his body by laying naked on his bed at ambient temperatures around the freezing point. He had consumed on average 250 mg prednisone daily over weeks. As we found out later his personal assistant travelling with him was giving him glucocorticoids through the infusion during his hospital stay. He developed a necrotizing septic phlebitis at the infusion site followed by a Pseudomonas aeruginosa sepsis with fatal multiorgan failure. This case illustrates the dangers of self-treatment by doctors and the difficulties in treating a physician.

Efficacy of minocycline and EDTA lock solution in preventing catheter-related bacteremia, septic phlebitis, and endocarditis in rabbits.

To determine the efficacy of antibiotic catheter lock solution in preventing catheter-related infections, silicone catheters were tunneled and inserted into the jugular veins of 18 rabbits. The catheters were challenged with an intraluminal injection of 10(5) CFU of slime-producing Staphylococcus epidermidis in 0.1 ml of water. The catheters were maintained on heparin (100 IU/ml) flush for the first 3 days. On day 3, quantitative blood samples for culture were obtained from the catheters and ear veins, which documented catheter-related bacteremia, and the rabbits were randomized to have their catheters flushed as follows: five animals were continued on heparin (100 IU/ml), five animals received vancomycin (3 mg/ml) with heparin (100 IU/ml), and eight animals received 3 mg of minocycline per ml with 30 mg of EDTA per ml (M-EDTA). All animals were killed at day 7. Blood, catheters, jugular veins, and heart valves were cultured quantitatively. Animals maintained on heparin developed catheter-related colonization, bacteremia, septic phlebitis, and endocarditis. Vancomycin-heparin partially prevented catheter colonization, bacteremia, and phlebitis (P = 0.2). M-EDTA completely prevented catheter colonization, catheter-related bacteremia, and phlebitis in all of the animals (P < 0.01). Tricuspid endocarditis was equally prevented by vancomycin-heparin and M-EDTA (P < or = 0.06). In conclusion, the M-EDTA catheter flush solution was highly efficacious in preventing catheter-related colonization, bacteremia, septic phlebitis, and endocarditis in rabbits.

Pylephlebitis after appendicitis in a child

Septic phlebitis of the portal vein, or pylephlebitis, is a rare but potentially severe complication of abdominal sepsis. The authors present a case of pylephlebitis after perforated retrocecal appendicitis in a child and discuss the etiology, presentation, diagnosis, and treatment of this disorder in the modern era. J Pediatr Surg 36:1574-1576. Copyright © 2001 by W.B. Saunders Company.

Die Bedeutung der Vena femoralis superficialis bei CVI

Septic phlebitis is characterized clinically by a local syndrome in an arm, the chest or a leg, by an irregular temperature (toothsaw curve), by blood cultures that are simultaneously or successively positive for one or several pathogenic microorganisms, by repeated, multiple infected embolism and by the possibility of endocarditis as a complication. Septic phlebitis occurs either spontaneously (staphylococcosis, syndrome of angina pectoris and infarction), or through secondary infection by secondary microbial colonization of a thrombosis of gynecological or obstetrical origin or, thirdly, as the consequence of venous catheterization (perfusion, pacemaker, explorations). Prevention is based on the selection of the material (silastic piercing catheters), the choice of the site of injection, the observation of strict surgical asepsis and of choice of the fluid injected (no corticoids, nor heparin which inactivates the oligosaccharides). As regards the curative treatment, no use should be made either of heparin or of anti-inflammatory agents (especially no corticoids); first of all, the material that has caused the thrombophlebitis should be withdrawn immediately; secondly, 24 to 36 hours later, a specific antibiotic treatment should be instituted and after two weeks, if still necessary, surgical ligation may be carried out of the inferior vena cava, the subclavian vein or the brachiocephalic venous trunk, depending on the localization of the phlebitis.

Puerperal septic pelvic thrombophlebitis: Incidence and response to heparin therapy

Objective: Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. Study Design: We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was ≤37.5°C for 48 hours. Results: During the 3-year study period 44,922 women were delivered at Parkland Hospital; among these 8535 (19%) were delivered by the cesarean route. There were 69 women who met criteria for prolonged infection, and 15 (22%) of these were found to have septic pelvic thrombophlebitis. Four had infection after vaginal delivery and 11 had been delivered by the cesarean route. Of 14 women randomly assigned to therapy, 8 were assigned to receive continued antimicrobial therapy without the addition of heparin and the other 6 were assigned to receive heparin therapy in addition to the antimicrobial agents. According to an intent-to-treat analysis there was no significant difference between the responses of women with pelvic infection who were and were not given heparin therapy. Specifically, women not given heparin were febrile for 140 ± 39 hours compared with 134 ± 65 hours for women who received heparin ( P = .83). Duration of hospitalization was also similar between the 2 groups at 10.6 ± 1.9 days for those with thrombosis who were given antimicrobial agents alone and 11.3 ± 1.2 days for women who also received heparin ( P > .5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 ± 4.1 days, compared with 10.9 ± 2.9 days for women in whom thrombosis was diagnosed ( P = .14). These women were followed up for ≥3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. Conclusions: The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection. (Am J Obstet Gynecol 1999;181:143-8.)

Thrombolytic therapy for catheter-related thrombosis

Thrombosis of the central venous system (CVT) occurs in 20% to 30% of patients with indwelling catheters. This complication is usually treated with anticoagulation, extremity elevation, and catheter removal. Thirty-eight patients with CVT at our institution were treated with thrombolytic therapy to rapidly resolve symptoms and avoid removal of the catheters. Complete clot lysis occurred in 36 of 38 patients (95%) within 1 to 5 days (mean: 2.4 days). Symptoms resolved with clot resolution. Thrombolytic therapy detected stenoses in 22 patients. Angioplasty was successful in 64% of these patients. Five catheters were removed. Complications occurred in six patients: nonfatal pulmonary embolus, three bleeding episodes, pain with infusion of urokinase, and an episode of septic phlebitis. This experience suggests that thrombolytic therapy is safe, rapidly resolves symptoms of thrombosis, uncovers anatomic abnormalities amenable to angioplasty, and allows central venous catheters to remain in place despite central venous thrombosis.