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Septic emboli

Reviewed and revised 2 January 2016

OVERVIEW

  • Septic embolism involves two insults:
    • the early embolic/ischaemic insult due to vascular occlusion, and
    • the infectious insult from a deep-seated nidus of infection
  • Early recognition and a high index of clinical suspicion are required
  •  Any hepatic abscess of unclear aetiology should prompt detailed investigation into possible remote source of infection

CAUSE

Origins of septic emboli include:

  • infectious endocarditis
  • infected intravascular device (e.g. pacemaker, ICD, VAD, CVL, PICC, vascath, vascular grafts)
  • septic thrombophlebitis
  • periodontal disease
  • perivascular infection
  • myxoma
  • vascular fistulae (e.g. aorto-intestinal fistula)

Septic embolism is more likely in the presence of underlying immunosuppression

CLINICAL FEATURES

  • spectrum from asymptomatic, incidental finding on imaging to devastating cardiovascular or cerebral events
  • pulmonary and paradoxical embolization can result from venous sources
  • any end organ may be affected

COMPLICATIONS

  • RESP: pulmonary nodules, abscess, empyema
  • CVS: mycotic aneurysms, endocarditis, paravalvular abscess, vascular occlusion (e.g. coronary)
  • CNS: stroke, spinal infarction, haemorrhage, meningoencephalitis, abscess
  • GI: mesenteric arterial emboli, visceral organ emboli
  • MSKEL: extremity emboli

INVESTIGATIONS

Laboratory

  • septic screen including multiple blood cultures
  • biopsy and tissue culture, PCR

Imaging

  • echocardiography
  • CXR
  • CT
  • MRI

Investigate for underlying immunosuppression

MANAGEMENT

Resuscitation

  • address life threats (e.g. septic shock)

Specific therapy

  • source control and treat underlying cause
    — e.g. infectious endocarditis
    — e.g. remove infected intravascular device
    — e.g. dental surgery
  • antibiotics
  • treatment specific to septic embolisation complications:
    — mycotic pulmonary aneurysm: coil embolisation
    — vascular obstruction: thrombectomy
    — percutaneous drainage
    — surgical drainage and repair

Supportive care and monitoring


References and Links

Journal articles

  • Stawicki SP, Firstenberg MS, Lyaker MR, Russell SB, Evans DC, Bergese SD, Papadimos TJ. Septic embolism in the intensive care unit. Int J Crit Illn Inj Sci. 2013 Jan;3(1):58-63. doi: 10.4103/2229-5151.109423. PubMed PMID: 23724387; PubMed Central PMCID: PMC3665121.

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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