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Septic nonsuppurative thrombophlebitis.

M J Zinner, G D Zuidema, B D Lowery

    Archives of Surgery (Chicago, Ill. : 1960)
    |February 1, 1976
    PubMed
    Summary
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    Nonsuppurative peripheral thrombophlebitis can cause life-threatening Gram-negative sepsis. Surgical vein excision effectively treated sepsis in 11 patients, with rapid recovery and no complications.

    Area of Science:

    • Infectious Diseases
    • Vascular Surgery
    • Critical Care Medicine

    Background:

    • Nonsuppurative peripheral thrombophlebitis is a recognized, yet often occult, source of sepsis.
    • Gram-negative bacillary sepsis originating from peripheral thrombophlebitis poses a significant clinical challenge.

    Purpose of the Study:

    • To investigate the efficacy of vein excision in treating Gram-negative bacillary sepsis secondary to nonsuppurative peripheral thrombophlebitis.
    • To highlight the importance of early diagnosis and surgical intervention for this condition.

    Main Methods:

    • Retrospective analysis of 11 patients with Gram-negative bacillary sepsis attributed to peripheral thrombophlebitis.
    • Involved peripheral veins were surgically excised in all patients.
    • Microbiological cultures were obtained from the excised veins.

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    Main Results:

    • Klebsiella-Enterobacter species were isolated from the affected veins in 10 out of 11 patients.
    • Patients did not respond to antibiotics alone until vein excision.
    • All 11 patients became afebrile within 48 hours post-excision and recovered without morbidity.
    • Seven cases were associated with standard intravenous needles, not cutdown procedures.

    Conclusions:

    • Surgical excision of the affected vein is a highly effective treatment for sepsis originating from nonsuppurative peripheral thrombophlebitis.
    • A high index of suspicion is crucial for diagnosing this condition due to subtle local signs.
    • Vein excision is a low-morbidity bedside procedure for managing this life-threatening sepsis.