Associations and outcomes of septic pulmonary embolism.
Associations and outcomes of septic pulmonary embolism.
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DOI：
10.2174/1874306401408010028
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发表时间：
2014-01-01
期刊：
影响因子：
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通讯作者：
Williams, David N
中科院分区：
文献类型：
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作者：
Goswami, Umesh;Brenes, Jorge A;Williams, David N
背景技术背景：脓毒性肺栓塞是一种严重但不常见的综合征，由于其广泛的临床表现和病因学，对诊断提出了挑战。目的：了解急性护理安全网医院患者中脓毒性肺栓塞的临床和影像学相关性。方法：我们对我院所有诊断为脓毒性肺栓塞的患者的影像学和电子健康记录进行了回顾性分析结果：在40例患者中确定了41例脓毒性肺栓塞发作，年龄17 - 71岁（中位数46）; 29例（72%）为男性。出现的症状包括：发热性疾病（85%）;肺部疾病（66%），包括胸膜炎性胸痛（22%）、咳嗽（19%）和呼吸困难（15%）;以及与外周感染灶（24%）和休克（19%）相关的疾病。感染来源包括：皮肤和软组织（44%）;感染性心内膜炎（27%）;和感染性外周深静脉血栓形成（17%）。35/41例（85%）为金黄色葡萄球菌菌血症。所有患者胸部CT均显示周围结节性病变。所有患者的治疗包括静脉注射抗生素。26例（63%）患者需要胸腔引流和/或外周积液引流。7例（17%）患者接受了全身抗凝治疗。八（20%）例患者死于各种并发症。结论：脓毒性肺栓塞的流行病学在过去十年中扩大了，增加了确定的肺外，非心脏来源。在肺外感染的情况下，持续发热、菌血症和肺部不适的临床特征应引起对该综合征的怀疑，胸部CT扫描的典型结果证实了诊断。抗生素、局部引流程序以及越来越多的抗凝治疗是成功结果的关键。
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.