Gram-negative septic thrombosis in critically ill patients: A retrospective case–control study

Abstract

Background: Data on septic thrombosis caused by Gram-negative bacilli (GN-ST) in intensive care unit (ICU) patients are currently limited. Methods: The aim of this retrospective case-control study (matched 1:3) performed over a 15-month period on ICU patients with bacteraemia, associated (cases) or not (controls) with GN-ST, was to assess 30-day mortality and clinical/microbiological features of GN-ST. Results: During the study period, 16 patients with GN-ST and 48 controls were analyzed. Polytrauma was the cause of ICU admission in 12 (75%) cases and 22 (46%) controls (p = 0.019). In no case of septic thrombosis was surgical debridement performed. The site of venous thrombosis was more frequently in the lower limbs, associated with bone fracture in nine out of 12 (75%) cases. The median duration of bacteraemia (22 days vs 1 day; p < 0.001) and time to clinical improvement (15 days vs 4 days; p < 0.001) were significantly longer in cases than in controls. On analysis of the receiver operating characteristics (ROC) curve, bacteraemia >72 h was significantly associated with GN-ST (area under the curve (AUC) 0.95, sensitivity 0.996 and specificity 0.810; p < 0.001). Finally, 30-day mortality was 20% in cases and 67% in controls (p < 0.001). Conclusions: Critically ill patients with GN-ST showed specific clinical features. Despite delayed bacteraemia clearance, targeted antibiotic therapy plus anticoagulation usually provided clinical improvement and a low 30-day mortality rate.

Predictive scoring models for persistent gram-negative bacteremia that reduce the need for follow-up blood cultures: a retrospective observational cohort study

“…Recently, one study revealed that FUBC was a useful diagnostic tool for differentiating septic thrombophlebitis in gram-negative bacteremia of patients admitted to the intensive care unit (ICU) for polytrauma [15]. If the patient had a high-risk of persistent GNB and risk factors for deep vein thrombosis, such as the presence of a central catheter, multiple traumas or admission to the ICU [16,17], further diagnostic evaluation, such as CT angiography and duplex sonography as well as FUBCs to differentiate septic thrombophlebitis, could be considered.…”

Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside

“…The case is of particular interest because of several reasons. The case is different from the condition of classical thrombophlebitis, which refers to the ab-externo inflammation of a thrombosed vein that always requires surgical debridement [6]; ST may be cured with prolonged targeted antimicrobial therapy and anticoagulation [1,[3][4][5]. GNB ST in…”

“…The case is of particular interest because of several reasons. The case is different from the condition of classical thrombophlebitis, which refers to the ab-externo inflammation of a thrombosed vein that always requires surgical debridement [6]; ST may be cured with prolonged targeted antimicrobial therapy and anticoagulation [1,[3][4][5]. GNB ST in particular represents a subtle and often misleading condition, with rapid clinical improvement once targeted antibiotic treatment commences, despite remarkable delay of bacteremia clearance [9,10,14,15].…”

“…Septic thrombosis (ST) is a serious and potentially fatal condition defined by the presence of an endovascular thrombus in the setting of associated bacterial or fungal infection [1][2][3][4]. The cornerstones of ST treatment include prolonged and targeted antimicrobial therapy and anticoagulation [1,4,5]. Furthermore, in selected cases surgical debridement may also be required [6][7][8].…”

Acute septic deep venous thrombosis of the lower extremities due to foreign body injury and infection: a case report

“…At present, iatrogenic factors related to venous catheter infection are the main causes of septic thrombosis [11][12][13][14][15]. Septic thrombosis caused by drug abusers repeatedly piercing their own deep veins without strict disinfection has also been reported [16,17].…”