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.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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